TOOLS/RESOURCES > Advance Care Planning FAQs
What is an Advance Care Directive (ACD)?
An ACD is a way to make your healthcare wishes known if you are unable to speak for yourself or
prefer someone else to speak for you. An ACD can serve one or both of these functions:
Power of Attorney for Healthcare (to appoint an agent)
Instructions for Healthcare (to indicate your wishes).
Is the ACD different from a Durable Power of Attorney for Healthcare?
The ACD was enacted by July 2000 legislation and replaced the DPAHC and the Natural Death Act Declaration. However, if you had already completed one of these forms that was valid before July 1, 2000, it is still valid now.
I've never completed an Advance Care Directive before. Why should I?
People of all ages may unexpectedly be in a position where they cannot speak for themselves, such as an accident or severe illness. In these situations, having an Advance Care Directive assures that your doctor knows your wishes about the kind of care you want and/or who the person is that you want to make decisions on your behalf.
Does this mean only one person can decide for me? What if I want others involved, too?
Often many family members are involved in decision-making. And most of the time, that works well. But occasionally, people will disagree about the best course of action, so it is usually best to name just one person as the agent (with a back up, if you want). And you can also indicate if there is someone who you do NOT want to make your decisions for you.
But I thought the doctors make all those life-and-death decisions anyway?
Actually, doctors tell you about your medical condition, the different treatment options that are available to you and what may happen with each type of treatment. Though doctors provide guidance, the decision to have a treatment, refuse a treatment, or stop a treatment is yours.
What if something happens to me and no form has been completed?
If you are not able to speak for yourself, the doctor and healthcare team will turn to one or more family members or friends. The most appropriate decision-maker is the one with a close, caring relationship with you, who is aware of your values and beliefs, and is willing and able to make the needed decisions.
My "values and beliefs?" But I haven't talked with anyone about these!
That's why it is a good idea to talk with family or close friends about the things that are important to you regarding quality of life and how you would want to spend your last days and weeks. Knowing the things that are most important to you will help your loved ones make the best decisions possible on your behalf. If your agent doesn't know your wishes, then he or she will decide based on what is in your best interest. Actually, the most important part of this is talking to your loved ones. Without that conversation, the best form in the world may not be helpful!
What if I change my mind?
You can revoke your form (or your oral instructions) at any time. Also, it's a good idea to try and retrieve old forms and replace them with new ones.
Do doctors or hospitals require a patient to have an Advance Care Directive form?
No, they cannot require you to complete one. But doctors and hospitals should have information available to you and your family about the form and your right to make healthcare decisions.
What kinds of things can I write in my instructions for healthcare?
You can, if you wish, write your preferences about accepting or refusing life-sustaining treatment (like
CPR, feeding tubes, breathing machines), receiving pain medication, making organ donations, indicating
your main doctor for providing your care, or other things that express your wishes and values. If you
have a chronic or serious illness, you also may want to talk with your doctor about specific treatments
that you could face and ask him/her to help you document your decisions on a POLST form.
A POLST form - I've never heard of that!
POLST stands for Physician Orders for Life-Sustaining Treatment and was adopted in California in 2009.
This is a voluntary form, which must be signed by you (or your agent) and your physician, and indicates
the types of life-sustaining treatment you do or do not want if you become seriously ill. POLST asks for
information about your preferences for CPR, use of antibiotics, feeding tubes, etc. POLST doesn't
replace your ACD, but helps translate it into medical orders that must be followed in all healthcare
settings (home, nursing home, hospital).
If I appoint an agent, what can that person do?
Your agent will make all decisions for you, just like you would if you could. Your agent can choose your
doctor and where you will receive your care, speak with your healthcare team, review your medical
record and authorize its release, accept or refuse all medical treatments and make arrangements for you
when you die. You should instruct your agent on these matters so he/she knows how to decide for you.
The more you tell them the better they will be able to make those decisions on your behalf.
When does my agent make decisions for me?
Usually the agent makes decisions only if you are unable to make them yourself, such as if you've lost
the ability to understand things or communicate clearly. However, if you want, your agent can speak on
your behalf at any time, even when you are still capable of making your own decisions. You can also
appoint a "temporary" agent - for example, if you suddenly become ill, you can tell your doctor if there is someone else you want to make decisions for you. This oral instruction is just as legal as a written one.
Are there other oral instructions that don't involve a written form?
Yes. You can make an individual healthcare instruction orally to any person at any time and it is
considered valid. All healthcare providers must document your wishes in your medical record. But it is
often easier to follow your instructions if they are written down.
Can I make up my own form or use one from another state?
Yes. That's why this law is so flexible. Any type of form is legal as long as it has at least thee things: 1) your signature and date, 2) the signature of two qualified witnesses, and 3) if you reside in a skilled nursing facility, the signature of the patient advocate or ombudsman. These signatures, however, must include special wording.
Sounds difficult. Do I need an attorney to help with this?
No. Completing an advance healthcare directive isn't difficult and an attorney is not necessary. But
actually the most important part of this is talking to your loved ones. Without that conversation, the
best form in the world may not be helpful!
OK, I'll talk to them, but what should I do with the form after I complete it?
Make copies for all those who are close to you. Take one to your doctor to discuss and ask that it be
included in your medical record. Photocopied forms are just as valid as the original. And be sure to keep a copy for yourself in a visible, easy-to-find location - not locked up in a drawer.
What if I change my mind?
You can revoke your form (or your oral instructions) at any time. Also, it's a good idea to try and
retrieve old forms and replace them with new ones.
Do doctors or hospitals require a patient to have an Advance Health Care Directive form?
No, they cannot require you to complete one. But doctors and hospitals should have information
available to you and your family about the form and your right to make healthcare decisions.