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Neurology Now:
DEPARTMENTS: Ask the Experts

What is an advance directive and who should have one?

Sabatino, Charles P.

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Charles P. Sabatino is assistant director of the American Bar Association's Commission on Law and Aging and a past president of the National Academy of Elder Law Attorneys.

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A: Attorney Charles P. Sabatino advises

An advance directive is a general term for any document that provides directions about your health care when you can no longer speak for yourself.

Unfortunately, an advance directive is often thought of as a document that is designed exclusively for older people. That's not the case. Most “right-to-die” cases have involved young people. There is a misconception that healthy people don't need to have an advance directive, but it is important to develop a plan while you still have the capacity to do so.

Figure. Charles P. S...
Figure. Charles P. S...
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Advance directives can take many forms and the laws governing them are different in each state. A living will, for instance, lists your instructions about life-sustaining medical treatments you want to receive if you become terminally ill. A durable power of attorney for health care enables you to appoint someone as your health proxy to make health care decisions for you when you are incapacitated. Appointing a health care agent or proxy, and talking to that person about your health care wishes, should be a priority Several advance directive forms are available. Select one with which you feel comfortable.

One form called “Five Wishes” covers these topics in non-legal terms and is becoming very popular.

More than just a legal document, an advance directive is an ongoing conversation about what's important to you. You can change it as your circumstances change. When you're young, you may not know what medical treatments you want, but you may be certain about who you want to make those decisions. If you're in your 70s or you have a serious illness and you know the course it is going to take, you may put in more detail.

While you don't necessarily need a lawyer to make an advance directive, an attorney is often in the best position to ensure that your stated wishes are followed. You may want to consult with an elder law attorney Elder law attorneys are specialists in health care and end-of-life decision-making. If you want to do it yourself, forms are available that comply with your state's requirements. This is a process that requires a lot of thought. I advise people to consult one of several available workbooks to help you think through this process, such as American Bar Association's Tool Kit for Health Care Advance Planning (listed below).

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For more information:

To learn how to obtain the American Bar Association's “Tool Kit for Health Care Advance Planning,” visit www.abanet.org/aging. Click on the “Tool Kit for Health Care Decision-Making Worksheets” link.

To download state-specific advance care directives, go to www.nhpco.org and click on “Advance Directives.”

For information on the Five Wishes program, click on www.agingwithdignity.org/5wishes.html

©2005 American Academy of Neurology

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