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Advance Medical Directives
(Living Will, Power of Attorney, and Health-Care Proxy)

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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Advance medical directive facts

• Advance directives are designed to outline a person's wishes and preferences in regard to medical treatments and interventions.
• When a patient is incapable of making his/her own medical decisions, a health-care proxy can act on the patient's behalf to make decisions consistent with and based on the patient's stated will.
• Advance directive policies may different from one state to another.
• Drafting a proper advance directive form may require assistance from your personal physician and an attorney.
• Advance directives are important documents that should be included with each individual's personal medical records.

Introduction to advance medical directives

Advance directives: The term "advance directives" refers to treatment preferences and the designation of a surrogate decision-maker in the event that a person should become unable to make medical decisions on her or his own behalf.

Advance directives generally fall into three categories: living will, power of attorney, and health-care proxy.

Living will: This is a written document that specifies what types of medical treatment are desired should the individual become incapacitated. A living will can be general or very specific. The most common statement in a living will is to the effect that

• if I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.

More specific living wills may include information regarding an individual's desire for such services such as

• analgesia (pain relief),
• antibiotics,
• artificial (intravenous or IV) hydration,
• artificial feeding (feeding tube),
• CPR (cardiopulmonary resuscitation),
• life-support equipment including ventilators (breathing machines),
• do not resuscitate (DNR).

Health-care proxy: This is a legal document in which an individual designates another person to make health-care decisions if he or she is rendered incapable of making their wishes known. The health-care proxy has, in essence, the same rights to request or refuse treatment that the individual would have if capable of making and communicating decisions.

Durable power of attorney (DPOA): Through this type of advance directive, an individual executes legal documents that provide the power of attorney to others in the case of an incapacitating medical condition. The durable power of attorney allows an individual to make bank transactions, sign social security checks, apply for disability, or simply write checks to pay the utility bill while an individual is medically incapacitated.

DPOA can also specifically designate different individuals to act on a person's behalf for specific affairs. For example, one person can be designated the DPOA of health-care or medical power of attorney, similar to the health-care proxy, while another individual can be made the legal DPOA.