What Is an Advance Directive?

There may come a time when you can’t make your own health care decisions because you are seriously ill or injured. You can create an advance directive to prepare for this possibility. Advance directives are documents that tell your loved ones and medical providers what you would want to happen if you can’t make those decisions on your own. Having an advance directive may also prevent the need for a guardianship. These are examples of advance directives:

• A health care power of attorney (sometimes called patient advocate designation)
• A living will
• A do-not-resuscitate order (DNR) 

Types of Advance Directives

An advance directive is a document where you write out what kind of care you want in case you can’t make health care decisions for yourself later. An advance directive can also include who you want to make those decisions for you. The following are several types of advance directives, and you can have one or more of the following documents.

Health Care Power of Attorney 

A health care power of attorney (health care POA) names someone to make health care decisions for you when you can’t make those decisions for yourself. A health care POA is sometimes called a “patient advocate designation.” The person you name in the document is called your patient advocate. A health care POA gives your patient advocate the power to make decisions about your physical and mental health care. You can use a health care POA to give your patient advocate specific instructions about the kinds of health care decisions you would like. For example, you can give them the authority to donate your organs upon your death or give instructions not to donate your organs. 

To learn more about health care POAs, read Making a Health Care Power of Attorney. 

If you want to make a health care power of attorney, use the Do-It-Yourself Health Care Power of Attorney tool. 

Living Will

A living will is a document that lists your preferences about end-of-life care. This document is intended to be proof of your wishes in certain health care situations. It does not give anyone the power to make decisions for you. Living wills can also include other major medical preferences, such as not wanting surgery or an autopsy. 

In Michigan, there is no law that recognizes living wills and makes them binding (enforceable). Living wills can still be helpful to give guidance about your health care preferences. If you have a health care POA, you should share your living will with your patient advocate so that they will have instructions about what decisions you want made. 

Do-Not-Resuscitate Order

A DNR tells first responders that you do not want to be resuscitated if your heart stops, or if you stop breathing. It does not give someone the power to make decisions for you. You do not have to be terminally ill before you sign a DNR. This order does not apply if you are in a nursing home or hospital. Nursing homes and hospitals have their own policies about resuscitation. 

Differences Between Advance Directives

The main difference between a health care POA, a living will, and a DNR is who makes the decisions. A health care POA allows someone else to make your health care decisions. A living will or DNR allows you to make decisions for yourself in advance. 

The difference between a DNR and a living will is what kind of treatment the document covers. A DNR order covers a very limited situation. 

These documents can overlap. Not everyone needs a health care POA, a living will, and a DNR. These documents can also be used together. For example, you may have a living will that requires extraordinary measures in terminally ill situations, and you may name a patient advocate to follow your wishes stated in your living will. For some family members or friends who are making very difficult decisions for a loved one, a living will provides reassurance they are doing the right thing.

Who Can Make an Advance Directive?

Advance directives are not just for older adults or people with a life-threatening illness. These documents are important for everyone. They make sure that you will have control over your future health care decisions. They also give you the chance to have conversations with your loved ones to tell them about the kinds of care you would or would not want.

You can make an advance directive if you are 18 or older and you are “of sound mind.” Being of sound mind means you can think, understand, and reason for yourself. 

Differences Between a Health Care POA and Guardianship 

A health care POA names someone to make health care decisions for you if you can’t make those decisions on your own. Guardianship is when a court finds that you are “incapacited” and appoints someone to make decisions for you. Incapacited means that you are no longer able to make decisions for yourself. The person who is appointed by the court is called a guardian.

If you have a health care POA or other power or attorney, it may not be necessary to appoint a guardian even if you are incapacitated.

A health care POA allows you to choose a person to make decisions about your health care when you can’t and also allows you to have conversations ahead of time with that person to explain your wishes. In a guardianship, the court chooses a person to make important decisions for you and this may even be against your wishes.

Once a guardian is appointed by the court, only a judge can remove them. This requires filing a petition with the court to remove the guardian. A health care POA is easier to cancel because you have control over who you name. If you have a health care POA, you can change or remove your patient advocate without involving the court.