The advance care plan or directive—also known as a living will—is a document that specifies which medical treatments you would want to receive if you were unconscious or otherwise unable to make your wishes known. Legally valid throughout the United States, an advance care plan goes into effect only if you can’t make decisions for yourself. You don’t need an attorney to create or validate one, and the document doesn’t expire until you replace it with an updated version.
An advance care plan can be as detailed as you want, explaining how far you’d like medical professionals to go to keep you alive, or what they can do to just keep you comfortable and avoid interventions. It can even contain instructions about donating your body to science or donating your organs after death.
In the plan, you designate primary and secondary healthcare agents, who can act on your behalf if you are incapacitated.
“Your primary and secondary agents can be anyone over the age of 18 whom you believe will follow your healthcare wishes,” says Natalie Rinaca, patient advocate for Sentara RMH Medical Center.
Why are Advance Care Plans Important?
Given modern medical technology, life often can be extended further than ever before, even in cases of life-threatening illness or a serious accident. However, there’s also the issue of quality of life.
“Over the years, the question people ask themselves about extraordinary life-saving measures has changed,” says Tammy Carter James, hospital and palliative care chaplain for Sentara Martha Jefferson. “It’s no longer, ‘Do we want these measures taken?’ More and more the question is, ‘Just because we can, should we?’”
James says that because people increasingly are answering “no” to both questions, it’s vital that they state their wishes in an official document like an advance care plan. Otherwise, it’s possible that a person might receive treatment that is unwanted and invasive, prolongs the dying process, leaves behind crushing medical bills, or goes against one’s values or beliefs.
“Life is unpredictable,” she says, “and if we don’t put our wishes in writing, unwanted things can happen to us. An advance care plan can help prevent that type of situation.”
In addition, James adds, an advance care plan releases family members from having to make difficult decisions in the midst of a crisis.
“An advance care plan can help eliminate a lot of potential doubt and disagreement among family members,” she says. “It truly is a gift to your loved ones.”
Rinaca agrees with James.
“If you can’t communicate with us, we don’t know what your wishes are,” says Rinaca. “By not deciding in advance, you leave the door open for someone else to decide for you. Without an advance care plan, the law states that we work down a chain of command, which includes, in order, your guardian, spouse, children, parents, siblings and other family members.”
Ironically, continues Rinaca, the most vulnerable population group is one that rarely thinks about planning for an end-of-life event—those 18-60 years old.
“People in that age bracket are actually the most likely to need an advance care plan unexpectedly,” she says.
How to Create an Advance Care Plan
Sentara RMH and Sentara Martha Jefferson make the process of creating and validating an advance care plan as easy as possible.
In addition to workshops for the general public and one-on-one assistance (making an appointment is requested), both hospitals distribute the “My Advance Care Planning Guide,” a comprehensive explanation of the directive that also contains important information about healthcare rights and the U.S. Living Will Registry.
The booklet contains a worksheet and the plan document itself. You just fill in the blanks and attach additional instructions, if needed. The booklet also includes a U.S. Living Will Registry Registration Agreement. All that is required to make the plan valid is your signature, the date the document is signed and the signatures of two witnesses. The document does not need to be notarized.
Once validated, you keep the original. Copies should be provided to Sentara RMH or Sentara Martha Jefferson, as well as to the healthcare agents named in the plan, your doctors, family members, attorneys, and other significant persons.
When the hospital receives your plan, it will be scanned into their electronic records. In addition, after the U.S. Living Will Registration Agreement has been completed, Sentara RMH and Sentara Martha Jefferson will enter the advance care plan into the registry free of charge.
Once the registry has the plan, you will receive a card with a code number. No matter where you are in the United States from that point on, all you have to do is to provide healthcare professionals with your registry number, and they can access your plan.
You can change your plan at any time—and you probably should, say James and Rinaca, whenever you experience a major life change. To update, just draw up a fresh document, sign it in the presence of two witnesses, and resubmit it.
Sentara RMH and Sentara Martha Jefferson aren’t the only places where you can get an advance care plan—many religious groups have their own version of the document, as do many nonprofit groups and other organizations.
Medical Power of Attorney
The person named as your primary healthcare agent—the one who speaks for you when you can no longer speak for yourself—is also known as your medical power of attorney. Unfortunately, the term has created some confusion.
“Medical power of attorney is different from financial power of attorney,” says Rinaca. “They are two totally different documents and two totally different sets of responsibilities. People have come to us and said they have ‘power of attorney.’ When we ask them to show us the corresponding documentation, sometimes they hand us a financial power of attorney authorization. In these cases, we have to tell them that financial power of attorney does not authorize any power over healthcare decisions. You have to appoint a medical power of attorney separately from a financial one—and that’s where the advance care plan comes in.”
Communication is Key
James and Rinaca stress the importance of communicating with loved ones and medical providers when creating an advance care plan. Both Sentara RMH and Sentara Martha Jefferson have chaplains who can help facilitate conversations about advance care plans.
“When you sit down with your loved ones to discuss your end-of-life healthcare wishes, it often ends up being a fairly intense conversation,” says James. “Having a facilitator to assist you in talking about these matters can be extremely beneficial.”