At some point in life, usually because of illness, many people will lose the ability to make medical decisions or communicate what they want from their care. The legal documents that allow you to spell out your healthcare decisions ahead of time – so you get the care you need and no less, and the care you want and no more — are called advance directives (also known as advance care plans).
Advance directives go into effect only when you lose the ability to make decisions. (Only healthcare professionals can determine if you do or don’t have the ability to make decisions.)
Advance Directives are the legal documents that allow you to spell out your healthcare decisions ahead of time. You should review your advance directives periodically to ensure that they still reflect your wishes. If you want to change anything in an advance directive once you have completed it, you should complete a whole new document.
There are two common types of advance directives that express your wishes about the health care you desire: Living Will and Choosing a Health Care Representative.
A living will indicates which medical treatments you may or may not want if you are dying or permanently unconscious.
A living will is a written, legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as your preferences for other medical decisions, such as pain management or organ donation.
A living will (instruction directive) is a part of your advance directive that specifically states your preferences for life-prolonging treatment. A living will only come into effect when you are unable to make medical decisions for yourself. This document can be filled out at any point in life and can be changed at any point as well.
- Five Wishes is the first advance directive to address personal, emotional, and spiritual issues in addition to meeting medical and legal criteria. It was designed to be accessible, legal, and easy-to-understand with the goal of helping people discuss and document their wishes in a non-threatening, life-affirming way.
- MyDirectives helps people record their medical treatment wishes, palliative and hospice care preferences, organ donation status, and other critical information on the device, and in the format that is most convenient for them. MyDirectives is secure, easy to understand, and always FREE to use.
Choosing a Health Care Representative
A durable power of attorney for health care designation for a health care representative is a document that names the person you choose to make healthcare decisions for you in the event you are unable to make health decisions for yourself. Your proxy can talk with your doctors, consult your medical records, and make decisions about tests, procedures, and other treatment.
Practitioner Orders for Life Sustaining Treatment (POLST)
The POLST form is a medical order, like a prescription, that is completed and used by medical professionals to inform them about what treatments a person would or would not want during a medical emergency. It must be signed by a doctor, physician assistant or advance practice nurse and the individual or decision maker. The POLST form is for people with serious illness or older adults approaching the end of life. The NJ POLST form gives specific care instructions related to personal goals of care, artificial nutrition, resuscitation and re-hospitalization. This form becomes part of a patient’s medical records, is valid in all healthcare settings, and follows the person whether they are in a hospital, nursing home or in hospice care.
For more information about POLST, click here.
New Jersey POLST Forms (PDF):
Do Not Resuscitate (DNR)
A DNR is a medical order issued in the hospital or nursing home stating that no steps will be taken to restart a person’s heart or restore breathing if they experience cardiac arrest or respiratory arrest. These steps typically involve cardiopulmonary resuscitation (CPR), which is not always successful and comes with risks, especially for individuals who are elderly or very ill. Your doctor will put the DNR order in your medical chart. DNR orders are not been portable from one healthcare setting to another, nor does it transfer to a home setting.
Advance directives should be made when the person with dementia still has legal capacity — the level of judgment and decision-making ability needed to sign official documents or to make medical and financial decisions. A lawyer can help determine what level of legal capacity is required for a particular document, as it can vary from one form to another. If you have concerns about the person’s ability to understand, a doctor will be able to help determine the level of his or her mental capacity. Early planning allows the person with dementia to be involved and express his or her wishes for future care and decisions. Early planning also allows time to work through the complex legal and financial issues that are involved in long-term care and eliminates guesswork for families. These documents should be completed as soon as possible after a diagnosis of dementia. If advance directives are not in place, the family must be prepared to make decisions consistent with what they believe the person would have wanted, while acting in that person’s best interest. It’s important to review legal documents as health status changes.