As a primary care doctor for more than 30 years, I know that when it comes to our personal health, most of us know we should schedule our annual check-ups with our doctors and advanced practice providers* (APPs), get our preventive health screening and even research the best ways to maintain our physical and mental health. However, there's a key component of our health that we often push to the back burner – creating an advance directive, which is a legal document that allows you to state your decisions around your medical treatment even if you are unable to voice them at the time.
While many people don’t wish to think about an advance directive as it includes discussing your wishes for end-of-life care, it is an important consideration for every adult over 18 and particularly seniors. Having an advance directive can provide you with peace of mind for yourself and your family as well as make sure that your medical wishes are known, respected and followed.
Where to start when creating your advance directive.
Creating an advance directive can be a five-step process that should involve thoughtful consideration of your medical wishes and discussions with your family as well as your doctor or APP. It is also important to note that if one of your medical wishes is not to have cardiopulmonary resuscitation (CPR) or be hooked up to machines at the end-of-life, you must also complete a Do Not attempt Resuscitation (DNR) form. The DNR form can vary by state and needs to be filled out and signed by your primary care doctor, and it may have a different name depending on which state you reside. Be sure to discuss what forms you need for advance care planning with your doctor or APP.
Here is the PREPARE™ five-step process to create your own advance directive:
- Choose a medical decision maker.
- Decide what matters most in life.
- Choose flexibility for your decision maker.
- Tell others about your medical wishes.
- Ask your doctor or APP the right questions.
I recommend using “PREPARE™ for your care” to my patients as they begin the process of creating their advance directive as they modify their form to be legal in all 50 states. The forms are free and available in English and Spanish, and the PREPARE™ website also has educational materials and short, instructive videos to help you.
What to do after completing your advance directive.
It is critical that you inform your loved ones and healthcare teams once you have completed your advance directive. It is especially important to talk with the person you chose to be your medical decision maker and your healthcare teams as this allows you to go through the document with them and make sure everyone is clear on what your medical wishes are. Having open communication early can help prevent last-minute confusion or changes in treatment plans.
Life is ever changing, and so too should be your advance directive. It's important to review your advance directive every decade and to make updates as significant events occur, such as:
- Change in health status due to serious health diagnosis, hospitalization or a decline in your overall health.
- Marriage or divorce.
- Death of your medical decision maker.
- Changes to your values or beliefs.
Having an advance directive allows you the ability to participate in your care planning even when you are unable to speak and makes sure your medical wishes are known by your family, helping to eliminate their stress and guilt at a difficult time. It's an act of love and foresight that can't be underestimated, and one that merits your time, consideration and completion.
For more information and personal stories on advance directives, please read our previous blog posts:
- How to Plan for a Quality End-of-Life
- PREPARING Patients and Loved Ones’ End-of-Life Wishes
- Conversation with a Caregiver
*An advanced practice provider is defined as a nurse practitioner or physician assistant.