Day 178 – Advance Health Care Directive

Few weeks ago, Jeff and I had dinner with the author of the blog Advance Directives Rock (her blog is awesome) who told us about Advance Healthcare Directive. If you don’t know what it is, you’re not alone. I had no idea what it was either – so read on.


What is an Advanced Health Care Directive?

In California, an Advance Health Care Directive is the legal document that lets you say, “If I am so sick or injured that I can’t speak for myself, then I choose this person to make decisions about my health care.  And just so you know, here’s how I feel about life support if I’m terminally ill or brain dead.”

If you have a preference regarding organ or tissue donation, autopsy, or disposition of your body after death, you can express that, too.

In legal terms, you’re creating a Power of Attorney for Health Care, or naming a health care agent.  You’re also giving directions about your preferred end of life care.  Some states call that part a “living will”, but in California we call it an Advance Directive.

By the way, not every state uses Advance Directives, and the laws about them vary from state to state.  We’re lucky in California because the statutory language is really generous in terms of what you can express, and what form it can take.

Death is such a taboo topic to discuss. Do you have suggestions on how to start the conversation about AHD?

Death is natural, yet it can be so hard to talk about.

One way to start the conversation would be, “Hey, I just found out about Advance Directives, and they sound pretty cool.  I’m thinking about making one.  Do you have one?”

Another way to bring it up is to use a recent news story.   For instance, “Did you hear that story about the guy who ended up in a coma after getting beat up at a ball game?  If something like that happened to me, I’d want. . . ”

Or, draw on a story that is closer to you.  “My friend’s mom has cancer, and she’s decided that if it comes down to it, she’d rather die at home than in a hospital.  I’ve been thinking about what I’d want if it were me.  I want to make an Advance Directive so people know what I want.  Do you ever think about what you’d want?”

Advance Directives are about life!  The focus is on what kind of care you want while you are still alive, but unable to speak for yourself.

Who should have an AHD?

Anyone who is 18 or older, and has an opinion about how they want to be treated when they’re really sick, on life-support, or near the end of their life.

The key is to make an Advance Directive before you think you need one.  Because when there’s a crisis, it’s often too late to create one.

If I’m married, doesn’t my husband/wife automatically have the authority to make decisions for me?

It depends.  Your spouse is the person who gets to make most decisions for you.  But according to the law, no one has complete authority to make all health care decisions unless you have clearly authorized that person to do so.  It becomes really important with end-of-life care.  It means that your spouse can’t choose to remove life support, even if you’re brain dead, unless you’ve given them full authority or there is clear and convincing evidence of your wishes.  An Advance Health Care Directive gives your spouse the power to act as your health care agent, and they can choose to refuse medical treatment if that’s what you want.  If your Advance Directive also captures your wishes about end-of-life care, it makes it a lot easier for you to get the kind of care you want.

Also, what if your spouse is with you in an accident?  Without an Advance Directive, the decision-making power typically flows to your adult children, then parents, then siblings.  With an Advance Health Care Directive, you get to choose alternate health care agents.  Who do you trust with your life?  It might be a friend rather than immediate family.

What are some important questions I should consider when preparing an AHD?

Take some time to reflect on what’s important to you.  Some questions to consider are:

Who do I deeply trust?
Who knows me well?
Do they live nearby, or far away?
What religious or spiritual beliefs are important to me?
What kinds of things comfort me and bring me pleasure?   Music, being read to, being at home instead of in a hospital, spending time with a pet. . .?
How do I feel about being on life support?  Is there a situation where I would prefer to be allowed to die naturally?
How do I feel about CPR?  Do I want it when I’m really sick or injured?
What does a meaningful quality of life mean to me?
What kind of experience do I want to have?

Where should I keep the form? Does it need to be submitted to a database?

The state maintains a registry, and there are a few database services out there, but they’re not very practical.  The best thing is to make sure the people who need to have a copy have one.

Give one to your doctor if you’re being treated for a serious illness.  Make copies and give them to your agents and alternates.

You can also create a wallet card stating that you have an Advance Directive, and providing the names and phone numbers of your agent and alternates.

For cyclists and runners, I also recommend getting an ID bracelet with your name, and the name and phone number of your emergency contact.  It’s an inexpensive and valuable precaution, especially in the Bay Area where people get hit by cars and buses all the time.

What if I change my mind?

It’s totally ok.  You can always give instructions verbally to your doctor.  Create a new document if you can.  Destroy the old one, and tell your agents to throw away their old copies.  If you have different versions, the latest date generally prevails.

It’s a good idea to review your document once a year to make sure it’s current.  As Ben Franklin said, “Nothing is certain but death and taxes.”  I suggest reviewing it at tax season.  Your Advance Directive should accurately reflect your wishes, which may change over time.

If I have any specific wishes as to how I want my body handled after death, do I put that in AHD?

Yes, there’s place to indicate your wishes about donating organs and tissues, and how you would like your remains to be handled.

Your AHCD grants authority to your agent to direct disposition of your remains, which is very important.  It makes it very easy for your agent to move forward with your wishes for burial or cremation.

Is AHD something I can complete on my own?

Absolutely.  There are a lot of free resources out there to help you do it.  A google search will turn up several free forms.  Check your local library for books on estate planning, elder law, or living wills.  Many of these include instructions on creating your own Advance Health Care Directive.

There is no single official form.  So long as it meets statutory requirements, it works.

What is the benefit of hiring an attorney to complete an AHD?

An attorney can answer questions you have along the way, and help write a custom document for you.  One attorney I know created an Advance Directive for a terminally ill man who wanted to make sure his family could not make any decisions for him – they held conservative religious beliefs, and had always disapproved of him and been unkind to him because he was gay.

An attorney can also help with any related issues, like estate planning, elder law, or mental health care.  They can create a Power of Attorney for Finance, or other estate planning documents, if you wish.

Working with an attorney can make the process less overwhelming, and you’ll also be sure that you get it done!

Final thoughts?

The people who love you might not agree on how best to take care of you.  By naming your health care agent, you can prevent potential family conflict.   And when you write down your wishes, it makes it easier on everyone because they don’t have to guess about what you’d want.

We make choices and give instructions based on our preferences all the time in our day-to-day lives.  We choose black beans over pinto.  We choose a window seat instead an aisle seat.  An Advance Directive is just another way of saying, “Hey!  Here’s what I want.”  It’s all about quality of life.

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