Many people today are worried about medical care they would be given if they should become

terminally ill and unable to communicate their wishes.  They don't want to spend months or years

dependent on life-support machines, and they don't want to cause unnecessary emotional or

financial distress for their loved ones.

That's why a growing number of people are taking an active role in their care before they become

seriously ill.  They are stating their health care preferences in writing, while they are still healthy

and able to make such decisions, through legal documents called advance directives.

Before deciding what choices about your care at the end of life are best, you should talk over the

issues involved with your family physician.  Find out the laws and forms that apply in your state.

Decide whether an advance directive is right for you.  Here are some basic facts about advance

A: Formal advance directives are documents written in advance of serious illness that state

your choices for health care, or name someone to make those choices if you become unable to

make decisions.  Through advanced directives, such as living wills and durable powers of

attorney for health care, you can make legally valid decisions about your future medical

A: Questions about medical care at the end of life are of great concern today, partly

because of highly publicized cases involving comatose patients whose families wanted to

withdraw treatment.  Many people want to avoid extending personal and family suffering by

artificial prolongation of life if they are in a vegetative state or when there is no hope

of recovery.  The best way for you to retain control in such a situation is to record your

preferences for medical care in advance and share your decisions with your physician, loved

Q: What does the law say about this issue?

A: A living will is  a document in which you can stipulate the kind of life-prolonging

medical care you want if you become terminally ill, permanently unconscious, or in a

vegetative state and unable to make your own decisions.  Many states have their own living

will forms, each with somewhat different requirements.  It is also possible to complete and

sign a standard form from a stationary store, draw up your own form or simply write a

statement of your preferences for treatment, as long as you follow the state’s witnessing

requirements.  A living will should be signed, dated, and witnessed by two people,

preferably individuals who know you well but are not related to you and are not potential

heirs or your health care providers.  A number of states require a notary or permit a notary

in lieu of two witnesses.  The living will should be discussed and shared with your

physician to make it a part of your permanent medical record.  Verify that the living will

is indeed in your medical record including your hospital chart.  Although you do not need a

lawyer to draw up a living will, you may wish to discuss it with a lawyer and leave a copy

A: A durable power of attorney for health care is another kind of advance directive:  a

signed, dated and witnessed document naming another person to make medical decisions for you

if you are unable to make them for yourself and any time, not just at the end of life.  You

can include instructions about any treatments you wish to avoid, such as surgery or

artificial nutrition and hydration.  The majority of states has specific laws allowing a

health care power of attorney, and provide suggested forms.  You can draw up a durable power

of attorney for health care with or without the advice of a lawyer; however most states do

A: Historically, living wills were developed first and health care powers of attorney were

designed to be more flexible and apply to more situations.  Today the distinction between

the two types of documents is becoming blurred.  It is possible to have both a living will

and a durable power of attorney for health care.  Some states combine them in a single

document that both describes one’s treatment preferences in a variety of situations and

A: Although it isn’t possible to specify for every possible procedure under every possible

circumstance, it is possible to decide what kind of treatment you would want in most

situations.  There are certain common conditions (terminal, irreversible brain damage and

dementing illnesses) and treatment commonly used in end-of-life situations (CPR,

ventilators, artificial nutrition and hydration, dialysis and antibiotics) that can be

discussed in advance.

Preferences can be clarified by thinking about and discussing with your family, friends and

others your views about death, being totally dependant on the care of others, the role of

family finances, the conditions that would make life intolerable to you and how artificial

life support would affect the dying process.  If you have questions about the kinds of

procedures that are often used when illness is severe and recovery unlikely, ask your

physician.  It is never too early to start this decision making process, and you should not

postpone it until you face serious illness.  Patients need to play an active role in

A: All states legally recognize some form of advance medical directive.  Even if a

particular instruction in an advance directive might not be enforceable under some

circumstances, it is better to express your wishes and intent in some kind of written

A: You may change or revoke these documents at any time.  Any alterations and any written

revocation should be signed and dated, and copies should be given to your family, physician,

and other appropriate people.  (For substantial changes, a new living will should be written

and witnessed.)  Even without an official written change, your orally expressed direction to

your physician generally has priority over any statement made in a living will or power of

attorney as long as you are able to decide for yourself and can communicate your wishes.  If

you wish to revoke an advance directive at any time, you should notify your primary

physician, family, clergyman, and others who might need to know.  If you consulted an

A: The majority of states have reciprocity provisions.  Even in those states that do not

specifically address the issue, there is a common law and constitutional right to accept or

refuse treatment that may be broader than the rights identified under the state law.

Because an advance directive is an expression of your intent regarding your medical care, it

will influence that care no matter where you are hospitalized.  However, if you spend a

great deal of time in more than one state you may wish to consider executing an advance

A: If there is no advance directive by the patient, the decision is left to the patient’s

family, physician, and hospital, and ultimately a judge.  Usually the family, physician and

hospital can reach an agreement without resorting to the courts, often with the help of a

hospital ethics committee.  However, many times the individual who has the authority to make

the decision is not the person the patient would have chosen.  There may be more

A: Many hospitals have ethics committees or ethics consultation services, one of whose

functions is to help in decision making about the end of life.  Physicians, nurses, social

workers, lawyers, clergy, patient representatives, and some time professional bioethics

discuss issues, advise on hospital policy, and review cases if there is a conflict or lack

of clarity.  Although they will often counsel a patient’s family and make a recommendation,