An “advance health care directive,” also known as a living will or advance directive, provides a legal mechanism for individuals to specify what actions should be taken for their health in the event that they are no longer able to make such decisions due to illness or incapacity. These instructions can prevent the need for anyone to “guess” what to do. By appointing a person or persons in this capacity, individuals can let their physician, family and/or friends know their health care preferences, including the types of special treatment they may want at the end of life, their desire for diagnostic testing, surgical procedures, cardiopulmonary resuscitation, and/or organ donation.
Although requirements sometimes differ from state to state, on December 1, 1991, the federal Patient Self-Determination Act (PSDA) went into effect. PSDA requires health care institutions to ask all adults admitted as inpatients whether they have an advance directive, and to inform these patients of their right to refuse treatment. The PSDA and advanced directive regulations nationwide assume that patients want, need, and appreciate information about medical technological intervention. It further assumes that health professionals and institutions will respect those decisions.
The Joint Commission addresses advance directives, end-of-life care, and surrogate decision-making standards in their accreditation standards for Hospitals. The elements of performance that accompany these standards include forgoing or withdrawing life-sustaining treatment or withholding resuscitative services. The Joint Commission defines an advance directive to include living wills, durable powers of attorney, do-not-resuscitate orders, right to die, or similar documents listed in the PSDA which express patient preferences.
Aging with Dignity is a national non-profit organization with a mission “to affirm and safeguard the human dignity of individuals as they age and to promote better care for those near the end of life.” Aging with Dignity promotes its resource Five Wishes, a document designed to let an individual’s family and doctors know:
- Who they want to make health care decisions for them when they can’t
- The kind of medical treatment they do and don’t want
- How comfortable they want to be
- How they want people to treat them.
- What they want their loved ones to know
Five Wishes meets the legal requirements in 42 states and is useful in all 50. Additional information for California residents about advance health care directives can be found at the State’s Office of the Attorney General Website, the Website for California Medical Association, and the California Hospital Association Website. California residents can even register an advance directive with the California Secretary of State.