Types of advance directives

“Advance directive” is actually an umbrella term that covers a few legal documents. These documents work together to clearly communicate your instructions for end-of-life care and include:

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Living wills

Think of a living will as a guidebook for your doctors and other medical professionals to follow. If you are ever in an end-of-life situation and can’t tell your health care providers what you want, they can consult your living will for guidance.

A living will should outline, as specifically as possible, what kinds of medical interventions you do and do not want. Commonly, it answers questions such as:

• Should doctors extend my life at all costs?

• If so, what treatments do I want and for how long?

• If not, when should they withhold or withdraw treatment?

• How should they manage my pain?

• Should they donate my organs?

“These questions can feel really big,” Cameron said. “It can be helpful to talk to your health care team about how best to answer them in a way that’s meaningful and right for you.”

Take cardiopulmonary resuscitation (CPR), for example. Depending on your age and overall health, you absolutely may want your medical team to provide it if your heart stops. On the other hand, CPR can be a particularly damaging intervention for people with age- or illness-related frailty. If this describes you, you may decide that its risks outweigh any potential rewards.

As you begin to gather your thoughts around these issues and prepare to discuss them with your doctor or other provider, here are some other common end-of-life treatments to ask about—so you can record your preferences about whether you want them, when, and for how long:

• Antibiotics

• Defibrillators

• Feeding tubes

• Dialysis

• Ventilators

One other thing to know: If you are enrolled in Medicare, Part B covers advance care planning as part of your annual wellness visit.

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Medical power of attorney

This document names a person—your “health care proxy”—who will make decisions on your behalf based on what they know about your wishes and personal values. Ideally, you will choose a loved one, trusted friend, or established caregiver to serve in this vital role of designated spokesperson.

“Not only that, but it’s also important that you have real conversations with your proxy about what you want,” Cameron advised. “While you won’t be able to anticipate every possible situation, these discussions can provide a solid foundation for your proxy to stand on. They won’t feel as if they have to guess during a stressful, vulnerable, and emotional time.”

There’s no legal requirement that you designate a medical power of attorney (also called “durable power of attorney for health care”).4 However, it’s in your best interest to do so. Otherwise, state law will determine who your health care proxy will be—and it may not be a person you’ve ever met.

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Some Helpful Terms

Discussing a health care power of attorney can get pretty confusing, here’s a quick primer of common terms:

• Power of attorney. This is a general term for a legal document that allows somebody else to make your decisions for you in the event that you can’t. For instance, if you had dementia or were in a coma.

• Financial power of attorney. This is a general term for a legal document that allows somebody else to make your financial decisions for you if you can’t.

• Health care power of attorney. This is a general term for a legal document that allows somebody else to make your medical decisions for you. You’ll sometimes hear this referred to as a medical power of attorney.

• Health care proxy. Also sometimes called a health care agent. You designate this person to make your health care decisions for you.

• Durable power of attorney. If your lawyer is drawing up a healthcare power of attorney, they’re almost certainly going to make it a durable power of attorney, meaning that if you become incapacitated, your proxy can keep making decisions for you.

• Nondurable power of attorney. There are several types of POAs, including a non-durable power of attorney. You might, for instance, have a financial advisor making investment decisions for you, but you may not want that continued if you’re in a coma. However, health care POAs are typically always durable unless there are extenuating circumstances.

• Advance directive. Also known as a living will, this legal document provides instructions for your medical care and goes into effect if you can’t articulate your wishes. It’s similar to a health care power of attorney, but these are written instructions, and you don't need someone to make decisions for you.

• Do not resuscitate order. This is a legal document stating that you don’t want cardiopulmonary resuscitation (CPR). Typically, a doctor will write this after a lengthy discussion with you or your health care power of attorney.

• Physician orders for life-sustaining treatment. (POLT FORMERLY KNOWN AS A DNR) These written orders are generally signed by the physician and the patient or health care agent, and your wishes for lifesaving measures are communicated to medical personnel.

• Guardian or conservatorship. Generally, a guardian refers to somebody who can make legal decisions for a minor under 18. A conservator is legally allowed to make decisions for somebody who can’t make them and is 18 or older.

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Why You Should Have a Separate Health Care POA

Many people have a durable power of attorney, designed to allow one person to make all decisions – financial, healthcare and anything else that might come up. However, many attorneys recommend separating health care and finances into two separate powers of attorney.

There are a lot of reasons to do so, says Theresa Viera, a family law attorney and the founder of Modern Legal, a Charlotte, North Carolina practice. She says that, for instance, you might have two people making decisions on a durable power of attorney. When two or more people make decisions on your behalf, it's called a joint POA. For instance, maybe you have one child making your financial decisions and another making health care decisions. She says you may not want your doctor to know who makes your financial decisions.

Why not? Keeping the financial and health decisions separate is just considered a best practice.

“A doctor’s general role is to prioritize a person's health and physical welfare and very life without the influence of financial factors, so there is no need for such financial information to be disclosed,” Viera says. “Essentially, keeping this information private avoids even the remote possibility of a financial circumstance influencing medical advice.”

But there are other reasons, too, for having a separate health care power of attorney, according to Viera.

“There is generally a different set of laws that apply to a health care POA versus a general and financial POA,” Viera says. For example, in North Carolina, a health care power of attorney and a durable power of attorney are governed by different statutes. “Application of the appropriate statute helps ensure that a POA is enforceable and abided by any and all respective parties, including the court,” she adds.

In other words, if you don’t want some obscure legal complication interfering with your health care and causing undue stress for your family, it’s best to have a health care POA in place.

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