What is an Advance Decision?

Marlene Garcia

An advance decision is a written or verbal statement that protects an adult’s right to make medical decisions in the event he or she becomes mentally incapacitated. It permits family members or caregivers to act in the best interests of the patient, who has formulated an advance decision while healthy. It can include the decision to refuse medical treatment. Also called a living will or advance directive, an advance decision may also apply to financial matters.

An advance directive tells the doctor how much medical intervention to give the patient during his or her terminal illness.
An advance directive tells the doctor how much medical intervention to give the patient during his or her terminal illness.

An advance directive can be verbal or written. If it pertains to refusing life-sustaining procedures, laws in most areas require a written document signed in front of witnesses. The document should include the date, explain the circumstances under which treatment should be withheld, and be written without coercion by others. These documents are considered legally binding and must be respected by doctors, hospitals, and emergency personnel.

The purpose of an advance decision is to allow a person to die with dignity, and to protect him or her from someone prolonging life if that is not the patient's wish. The process also sets guidelines for family members and friends to resolve disputes over medical care for someone mentally or physically incapable of directing his or her care. An advance decision is based on the right of a person to be involved in medical decisions even when someone else may not agree.

A psychiatric advance decision applies to someone who suffers a stroke, head injury, or other illness that affects his or her mental ability to make decisions. Alzheimer’s and dementia typically fall into this category, covering decisions that can change from day to day for some patients. A psychiatric advance decision may apply to any situation where a person cannot adequately make treatment decisions alone because he or she may not understand the options, cannot remember prior decisions, or cannot communicate effectively with caregivers.

Another option for making decisions that apply to the future can be done through a power of attorney. A personal power of attorney gives a selected person the right to make medical decisions for someone else. Financial powers of attorney grant the right to handle finances for someone unable to manage his or her own affairs. These legal documents might appoint a family member, lawyer, or friend to make decisions for a person who becomes incapacitated.

People who draft an advance directive should make sure someone knows of its existence. Some people carry a card or note with them that identifies a person who knows an advance decision exists. The document should be reviewed periodically and changed if necessary. For example, refusal of medical treatment for religious reasons may no longer be applicable if the person who wrote the directive changes religions.

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