The Patient Self-Determination Act¹ requires health care facilities to provide information about the patient’s right to choose and refuse treatment. An advance directive is a legal document used as a guideline for providing life-sustaining medical care to a patient with an advanced disease or disability who is no longer able to indicate his own wishes. Advance directives include living wills and health care proxies.

All patients should be encouraged to have an advance directive as part of any admission, before any routine medical treatment, or at their primary doctor’s office on annual physical examinations. All adults, regardless of their current health status, should make their preferences about medical treatment known before any serious injury or unplanned illness occurs. The advance directive should be discussed with the patient’s doctor, family, and health care proxy.

If a person is terminally ill or in a persistent vegetative state or coma, a living will instructs health care providers about the patient’s preferences about life-sustaining treatment. In making a living will, a legally competent patient states which procedures he does or doesn’t want carried out, such as endotracheal intubation and mechanical ventilation, feeding tubes, artificial nutrition and hydration, antibiotics, dialysis, and cardiopulmonary resuscitation. The living will goes into effect when a person can no longer communicate his choices on medical care. (See The living will, page 8.)

In the health care proxy (also called durable power of attorney for health care), the patient designates another person to make decisions about medical care if the patient can’t make his own decisions. (See Health care proxy, page 9.)