Why You Need an Advance Directive (And How to Put One in Place)
An advance directive takes the guesswork out of your medical decisions and lifts an immense burden off your family. Here is everything you need to build yours.
An advance directive is an often overlooked part of estate planning, but it shouldn't be. This set of critical legal documents clarifies your medical care wishes if you become incapacitated. After all, most people want to leave some kind of legacy after they pass away, but many forget to think about what may come before.
"An advance directive is a gift to the people who will do the talking for you," says Rory Farrand, senior consultant at Confidis Consulting. "It takes the guilt and the stress of that decision away from them. It’s a kind and gentle thing to do for the people that love you."
An advance directive can help you with your own end-of-life planning, such as palliative or hospice care. And if you are concerned about a loved one with a new dementia diagnosis or serious chronic illness, the advance directive is a key tool to protect their wishes. Think of it not as one document to sign, but as a process of figuring out what you need, talking with your doctor and loved ones, and then setting up legal structures to formalize your plan.
From just $107.88 $24.99 for Kiplinger Personal Finance
Become a smarter, better informed investor. Subscribe from just $107.88 $24.99, plus get up to 4 Special Issues
Sign up for Kiplinger’s Free Newsletters
Profit and prosper with the best of expert advice on investing, taxes, retirement, personal finance and more - straight to your e-mail.
Profit and prosper with the best of expert advice - straight to your e-mail.
Why do I need an advance directive?
While an advance directive allows you to specify someone to make medical decisions for you if you cannot do so on your own, there is much more to it than that. It also clarifies what to do in certain medical situations that leave you unable to manage your care or make decisions.
“I have kids, and if I became incapacitated, I would never want them to make the decision whether or not to take me off life support,“ says Evan Beach, founder and president of Exit 59 Advisory. "It's too heavy a burden on somebody else."
An advance directive also lets you specify if you want to be an organ donor. Farrand says you can even specify if you want to donate anything beyond organs, such as your cornea, skin, tissue, bones, veins or whatever else is viable. "We always have a dearth of viable organs at all times," she says.
"Everybody over 18 should have one." — Evan Beach
Evan Beach
For these reasons, all adults should have an advance directive. Yet only about a third of U.S. adults have one, according to a study published in the journal Health Affairs.
If you cannot communicate and don't have an advance directive on file, your healthcare provider will attempt to reach an immediate family member, who will then be tasked with making decisions on your behalf.
Some states have a family agency act that designates the order of priority governing which family member must make decisions on your behalf if you have no advance directive. If you have no immediate family, then the healthcare provider may make the best decisions they can on your behalf until a legal surrogate is identified. Different states have various rules governing such situations.
What types of documents make up an advance directive?
Here are the standard documents that you may wish to include in your advance directive.
- Living will: A living will provides guidance for terminal illness or unconsciousness, when you can no longer make decisions about your care. It specifies the treatments you do and don’t want in that situation.
- Medical power of attorney (POA): A medical POA designates someone you trust to make medical decisions for you if you cannot do so. Importantly, a durable medical POA gives the person the authority only to make medical decisions on your behalf — not financial decisions. Another term for a medical POA is a healthcare power of attorney or healthcare proxy.
- HIPAA Authorization: A Medical Power of Attorney often needs an accompanying HIPAA release form. Without it, doctors can legally refuse to share your medical records with your healthcare proxy, making it impossible for them to make informed decisions.
Here are some additional documents you might consider, depending on your situation.
- POLST or MOLST: This portable medical order informs healthcare providers and facilities of your wishes for end-of-life interventions, including emergency medical care, resuscitation, intubation or use of a ventilator. Depending on your state, it may be called a Provider Orders for Life-Sustaining Treatment (POLST) or a Medical Orders for Life-Sustaining Treatment (MOLST).
- Do-not-resuscitate (DNR) order: This order tells healthcare providers not to implement cardiopulmonary resuscitation, better known as CPR, if you stop breathing or your heart stops beating. It is often reserved for those who are terminally ill.
- Mental health or psychiatric advance directive (PAD): This directive allows someone with mental illness to express their treatment preferences before a crisis occurs in case they become unable to make their wishes known. The legal guidelines for PADs vary by state. PADs are a fairly new tool for patients and clinicians alike.
- Advance directive for dementia: If you or a loved one is facing an Alzheimer's or dementia diagnosis, a standard directive may not be enough. This specialized document lets you state your preferences for different stages of the disease, covering issues like assisted nutrition, hydration, and comfort care as cognition declines.
How do I get an advance directive?
Medicare beneficiaries can get advance care planning for free under Part B. During your next annual wellness visit, ask your doctor about a living will and a healthcare proxy. However, Medicare will charge you if you have this conversation with your doctor outside of your wellness visit.
For those not on Medicare, you may want a lawyer to draw up your advance directive to ensure that it clearly expresses your wishes and meets all legal requirements in your state. If the word "lawyer" makes you see dollar signs, try some of the tips we've put together on how to save money on estate planning.
Check your state's required documentation if you cannot afford an attorney's assistance. Some websites also enable you to create your own legal documents, providing some guidance to help ensure your final document checks all the necessary boxes for legality. Farrand pointed to the Five Wishes advance directive document as one example.
Almost all states require two witnesses (who usually cannot be relatives or healthcare providers) and/or a notary public to sign the document.
Where should I keep my advance directive?
Store your completed advance directive where a family member or legal representative can easily find it in an emergency. You could also store copies in a home safe.
Never keep your original advance directive in a bank's safe deposit box, as it would be difficult to access quickly. It's also a good idea to make copies of your advance directive and keep one in your car, in your wallet or purse and on your refrigerator (EMTs are trained to look there).
Android Medical ID and Apple Health let users list emergency contacts and indicate whether they have an advance directive right on their lock screen.
You should also provide a copy of the document to your primary care or other healthcare provider. It's also a great idea to upload it to the national U.S. Advance Care Plan Registry in case you're traveling or being treated by a different healthcare facility than the ones you usually frequent.
Common pitfalls with advance directives
Aside from not having a living will or advance directive, the other common pitfall is not being clear or specific enough in explaining what you want. Unfortunately, a lack of experience with certain medical conditions and available treatment options can make it hard to anticipate what steps you want taken.
If an advance directive does not give clear instructions, it can result in a lack of care because it may be interpreted as a blanket do-not-treat statement. On the other hand, there is always a chance that family members will opt for far more care than you would wish for at the end of your life.
For example, some common questions that should be addressed in an advance directive include the use of ventilators or feeding tubes, DNR orders, and any other specific areas of concern you might have.
Don't put it off, and keep it current
Of course, no one can anticipate what medical problems or accidents might befall them in the future, especially years in advance. However, the best way to ensure your wishes are followed is to put an advance directive in place with clear instructions. Be sure to update it every five years, or after a major life change or diagnosis.
Related content
