Mayo Edge: Work through advance-care planning process with people you trust

DEAR MAYO CLINIC: Every time I go to my doctor I'm asked if I have an advance directive. What exactly is it, and at what age should I start thinking about this?

An advance directive is part of the advance care planning process. In this process, you look at your goals and values, and express your preferences for certain types of medical care based on these goals and values. It's a process you should work through with the people you trust: your family, friends and medical provider. When you are ready to put your thoughts and preferences on paper, the actual form you fill out is an advance directive. It's a legal document that goes into effect only if you are incapacitated and unable to speak for yourself.

At some point, nearly three-quarters of all people will be in a medical situation where they cannot communicate their wishes to their health care providers. This can happen to young people, as well as those who are older. Accidents, devastating events and unforeseen medical situations affect people of all ages. Having an advance directive makes clear to your health care team what you do and do not want in those situations.

Although they are extremely helpful to have in many medical circumstances, about two-thirds of older adults in the United States don't have an advance directive. Many people don't create an advance directive because they assume their spouses or children already know what they want. But it's very difficult for your loved ones to clearly understand and follow through on your preferences if you haven't specifically talked about them.

So, the first step in creating an advance directive is to take time to think about your health goals, your health values and the types of treatment you would or would not want in a serious or life-threatening medical situation. Then have a focused conversation about those topics with the people closest to you, such as your spouse, adult children, other family members, close friends, or members of your faith community. Talk to your primary care provider, too. He or she can help answer questions, identify other issues to think about and clarify any areas that are unclear.


Once you've talked with others and made your decisions, formalize them in an advance directive. In general, there are two main types of advance directives: a living will and power of attorney for health care, also called a health care proxy.

A living will gives instructions to your health care team about your medical care preferences. This written legal document usually covers end-of-life care in detail. It typically spells out the types of medical treatments and life-sustaining measures you want and don't want, such as mechanical breathing, tube feeding or resuscitation.

It can be hard to cover every possible circumstance in a living will. So it's also a good idea to designate a person who has power of attorney for you in health care situations. Using your living will and previous conversations as a guide, that person has the legal authority to make medical decisions for you if you cannot do so for yourself.

To create a legal advance directive, check with the requirements in your state, as they differ somewhat among the states. Health care organizations often have advance directive forms available, so you can ask your doctor's office or hospital for the forms you need.

When you make thoughtful choices about your medical care preferences, talk about these preferences, and document them in an advance directive, you not only help to ensure that you get the care you want, but you also relieve stress and guilt in the people closest to you if they ever need to make tough medical decisions for you. An advance directive really is a gift you give yourself, as well as your loved ones. -- Ericka Tung, M.D., Primary Care Internal Medicine, Mayo Clinic, Rochester.

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