Advance Directives Speak for You When You Can't Speak for Yourself

(This article apepared in the July/August 2003 issue of The American Postal Worker magazine.)

Joyce B. Robinson, Research & Education Department Director

Less than 25 percent of Americans have expressed their thoughts in writing about how they want to be cared for at the end of their lives. Although most people avoid the subject, it's important to have an "Advance Directive" to ensure that your wishes are carried out if a serious illness deprives you of the capacity to make health-care decisions.

"Advance Directive" is a general term that refers to your oral and/or written instructions about your medical care in the event that you have become unable to speak for yourself. The states have various regulations on advance directives. These documents most commonly are called either a Health Care Directive or a Health Care (Medical) Power of Attorney.

A Health Care Directive informs your doctor and family of your wishes about your health care, including decisions about life-sustaining treatment.

A Health Care (Medical) Power of Attorney allows you to designate an "agent" to make medical decisions for you if you are unconscious or otherwise incapable of making decisions yourself.

Agents do not have to be medically trained, nor reside in the same state as you. But they must be available if a medical crisis occurs.

State Law Involvement

If you do not have an advance directive and you are unable to make health-care decisions, decisions are normally made in the following order of authority:

• The patient's legal guardian;
• The agent identified on the patient's Health Care (Medical) Power of Attorney; 
• A surrogate.

Many state laws place the decision-making power in the hands of "surrogates." Surrogates generally are family members who are designated to make health-care decisions in the following order of authority:

• The spouse, unless legally separated; 
• Adult children by a majority decision;
• Parents;
• The domestic partner if the patient is unmarried;
• Brother or sister;
• A close friend willing to become involved in the patient's health care.

When none of these people can be located, the patient's primary physician may make health-care decisions after consulting with the institution's ethics committee. Most states' laws say that when an ethics committee is unavailable, discussion with a second physician is all that is necessary.

Filing Requirements

You do not need a lawyer to complete a Health Care (Medical) Power of Attorney or Advance Directive form. However, it is suggested that these documents be witnessed and notarized.

The witness must state that you signed freely and that you had the capacity to understand what you were doing. The witness may not be: the individual you have named as your agent; someone related to you by blood, marriage or adoption; someone who will benefit from your estate; or your health-care provider.

Document Storage

Keep the original copies in a safe place at home where you or your family members can easily locate them. Give copies to your doctor, the agent you named in your Health Care (Medical) Power of Attorney, and to family members.

Carry a wallet card stating that you have a living will, as well as where the original is located and who to contact about it. Should you change your mind and revoke your living will, be sure to destroy all the original copies.

If you would like to receive a sample copy of a Health Care (Medical) Power of Attorney or a Health Care Directive form, please contact me: Joyce B. Robinson, Director, Research and Education Department, 1300 L St. NW, Washington, DC 20005, or fax a request to 202-216-2649.