A document called an “advance health care directive” lets your loved ones know exactly what your wishes are, whether you would want your life prolonged by any means necessary or prefer to have some treatments withheld. An advance directive lets you give your family, your physician and other caregivers instructions about the types of treatment you want.

At St. Luke’s Hospital, all patients over age 18 (or emancipated minors) are asked whether they have an advance health care directive upon admission to the hospital. If not, the hospital will provide them with information, and they may request a state-approved form, available in English or Spanish. A social worker from the Case Management/Social Services Department will meet with patients and their families to help them through the process. The best time to fill out an advance directive, however, is when you are healthy – not at a hospital when you’re already facing a health care crisis.

“Having your wishes written down helps us to provide the exact treatment options you desire,” says Medical Social Worker Eva Woodward, MSW. “Some people want all possible treatments used to continue their life, while others don’t want any extraordinary measures taken. There is no ‘right’ or ‘wrong’ choice. It’s strictly your decision.”

Advance directives are important legal documents that should be completed carefully and thoughtfully, outlining not only what kinds of treatments you would want if you became incapacitated, but also who you would want to make those critical decisions for you. In some cases, those determinations can become quite complicated – such as when there is discord in the family – and you might even wish to consult an attorney before completing an advance directive.

“People really need to talk with their families when preparing an advance directive,” Woodward says. “I have had many, many family meetings to determine the course of treatment when the patient had no living will. It is so much easier for the families if patients have made their wishes known. We also encourage patients to consult their physicians when preparing an advance directive to learn about various procedures used to prolong life.”

Advance directives can take various forms, with laws varying from state to state. In California, an advance health care directive combines a “living will” with a “health care power of attorney” (HCPOA). A living will allows you to state whether you want your life prolonged if you will die soon from a terminal illness or are permanently unconscious. The HCPOA allows you to name someone as your “agent” to make medical decisions for you if you are unable to do so.

In California, the advance health care directive also lets you specify your wishes regarding treatment to alleviate pain and donation of organs at the time of death. The advance directive generally goes into effect only if your primary care physician determines that you are unable to make your own health care decisions. You can revoke or revise your advance directive at any time.

California requires that advance directives be notarized or witnessed by two people who know the individual making the advance directive. One of those witnesses cannot be related by blood, marriage or adoption, and neither witness can be the person who is designated as the “agent.” The individual’s physicians, nurses or health care providers are not allowed as witnesses.

Standard forms for advance directives may seem difficult to understand, since they use a lot of legal terminology. Another option that is becoming popular is a form called “Five Wishes,” available from the non-profit agency Aging With Dignity (www.agingwithdignity.com or 1-888-5-WISHES). The Five Wishes advance directive, which is legally accepted in California and many other states, is written in everyday language, rather than in technical terms.

Whether you choose to complete a standard advance directive form or another state-approved form such as Five Wishes, you should always keep the original copy in a safe place and provide copies to your physician and hospital. You also should make sure your agent and family members have copies or ready access to the documents.

“It used to be pretty rare for a patient to have an advance directive prepared before being admitted to the hospital,” Woodward says. “For many people, talking about issues of mortality was ‘taboo.’ As a result of the publicity surrounding the Terri Schiavo case, however, more people are aware of this issue, and we are seeing more completed forms when patients are admitted. That is perhaps the only positive outcome of her tragic story.”

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