Advanced Directives

Why, When and Who?

Just the term “advanced directives” can sound ominous.

After all these terms are part of this “will” and “estate planning” thing right?

That means you are planning for your death, right?


Advanced directives apply to anyone. They are more than just a living will. Whether you’re young or not so young they apply. What they do is indicate your choices regarding certain situations. And it definitely signals you care about yourself and you care about those that love you.

One of the biggest court battles that captured the attention of the U.S. (and around the world) regarding the topic of advanced directives was that of Terri Schiavo. This case was fought in Florida, just a few miles from where I sit at this moment. This was a woman that went to a party one night, had a few drinks and fun with her husband and friends and slipped into a coma the next day. They never really determined why this happened but it did. She was in her 20’s at the time.

As the years’ wore on and on, her condition did not resolve itself, she was in a permanent vegetative state. Here is where the question of advanced directives comes in. If Terri had advanced directives there would have been no question what she would have wanted. Would she have wanted to be kept alive in this state, or would she have wanted to die a natural death?

And so started the war between her husband and her parents. Her husband said they had talked about this subject and Terri would not have wanted to be kept alive by a feeding tube. Her parents disagreed. As any parent would, they fought to keep Terri alive. After hundreds of thousands of dollars were spent on attorneys and court battles her husband was given the right to make the final decision.

This was a tragic situation that could have been avoided with a small amount of paperwork and a few signatures.

I don't want to be a burden, but what do I need?

So let’s talk about advanced directives and what they consist of and what they mean.

Advanced Directives is the term given to a series of forms that lets you predetermine what your wishes would be if certain circumstances evolve.

There are several main forms in you will need to consider. We will discuss each in depth.

The first is the Living Will. I have written a separate page on Living Wills and discussed them thoroughly.

The second is a Medical Power of Attorney or Healthcare Oroxy. This is also known as a health care surrogate. Read a complete explanation of Healthcare Proxy here.

There is also the Durable Power of Attorney. Here is a discussion on POA.

The last Advanced Directive we will want to discuss is the Do Not Resuscitate.

Where do I start with this?

There are some natural concerns regarding advance directives. Let’s address some of the most prevalent concerns right now, before we get into detail.

First and foremost I think everyone agrees that these documents are very important to the person but also important to their family. So most people wonder, do I have to go to an attorney and pay lots of money to get these done?

Well that depends on your state of residence. There have been many efforts to come up with forms that would be accepted in all states. Unfortunately that is not currently the case. With a little research you can come up with forms that are accepted in your state and they should be legal and enforceable. There are several web sites that can guide you on this. Here are a few.

Aging with Dignity

This website has a program called “My 5 Wishes”. You can download these forms, along with complete instructions to make them valid. These forms are accepted in 42 of the 50 states. This is an excellent resource if you may travel. The forms are also available in 26 different languages.

Compassion and Choices

This web site has a map of the US and you can click on your state and download the forms you may need for that state. They also have telephone numbers you can call for more information.

Caring Connections

This site will also let you download state specific forms.

Be sure to follow the instructions on the forms and make sure they are signed, notarized and made legal.

I have other questions........

What if I am not ready to relinquish control of my decision making. Can I be forced to do what my surrogate wants?

No. As long as you have the ability to communicate to your physician and address your needs and concerns you will remain in control. If there is a mental capacity issue that will be determined by several physicians before any action is taken.

Everyone wonders “if I am in a weakened state, will people take advantage of me and “send me along” before I am ready?

The short answer is no. Most states require on opinion of a second physician to confirm the life threating condition before allowing the surrogate to make decisions.

Do I have to renew my advanced directives every so often?

No, they do not expire. You can, however, change your advanced directive which would make the former one invalid.

What if I travel to another country?

You would have to research what that country does for advanced directives as it is not likely yours from the US would be legal there.

Who do I select to take on this responsibility?

You would want to select a person you can count on to carry out your wishes. Sometimes close family members have a hard time letting go, and can delay the process. You want someone that will look out for your best interests. If a family member does not want to, you can ask a pastor, friend, or a professional like a fiduciary service. Many states will not allow a health care provider to be a surrogate. Also the person that is your surrogate does not necessarily have to be the same person that is your Personal Representative for your will, trustee for your trust or your financial POA.

Carefully read the information provided here and discuss all decisions with your spouse, family, pastor and doctor.

It will give you peace of mind to know they will not be caught trying to decide.

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