Questions and Answers About Advance Directives

Q. Why are we giving you this material?
A. Someday you may become too sick to make your own decisions about your medical care. If that happens, then decisions will have to be made for you. If you haven't left any instructions, no one will know what you would have decided. This pamphlet helps you think about ways of making your wishes known ahead of time.

Q. What is an advance directive?
A. Advance directives are documents signed by competent persons giving direction to healthcare providers about treatment choices in certain circumstances. There are two types of advance directives:

• A durable power of attorney for healthcare allows you to name a "patient advocate" to act for you and carry out your wishes.
• A living will, although not recognized by Michigan statute, allows you to state your wishes in writing, but does not name a patient advocate.

Q. Your right to make medical treatment decisions
A. As a competent adult, you have the right to decide to accept or refuse any medical treatment. "Competent" means you understand your condition and the consequences of your decisions. As long as you are competent, you are the only person who can decide what medical treatment you want and do not want. Healthcare professionals will give you information and advice about the pros and cons of different kinds of treatment. You have the right to choose what options are best for you, including, in most cases, the option to refuse treatments, even if your refusal of that treatment might hasten your death.

Q. Why have an advance directive?
A. Many people have strong feelings about the kind of medical care they would like to receive or refuse in certain circumstances. An advance directive allows you to clearly state your feelings. Some questions to consider are:

• Who would you like to make treatment decisions for you, if you become unable to do so?
• What kind of medical treatment would you want if you had a severe stroke or other medical condition that made you dependent on others for your care?
• How do you feel about ventilators, surgery, resuscitation (CPR), drugs or tube feedings if you were to become chronically or terminally ill, unconscious and not likely to wake up, or senile?
• What sort of abilities (mental, physical, social) are important for you to enjoy living?
• Do you want to receive every treatment your caregivers recommend?

Q. Must I have a durable power of attorney for healthcare?
A. No. You have this option. No one can require you to have a durable power of attorney for healthcare. You can make your wishes known by talking with your family or your doctor or by writing them down, but unless you have a durable power of attorney for healthcare, a patient advocate does not have legal authority to act for you.

Q. Why might I be unable to participate in medical treatment decisions?
A. There might be a temporary loss of ability to make or communicate decisions, if one were knocked unconscious in a car accident or had a stroke. There might be a long-term or permanent loss through a degenerative condition such as Alzheimer's disease.

Q. What powers can I give a patient advocate?
A. You can give a patient advocate power to make those personal care decisions you normally make for yourself. For example, you can give your patient advocate power to consent to or refuse medical treatment for you, to contract for home healthcare or adult day care, arrange care in a nursing home or move you to a home for the 24-hour healthcare.

Q. Can I give my patient advocate the right to make decisions to withhold or withdraw life-sustaining treatment?
A. Yes, but you must express in a clear and convincing manner that the patient advocate is authorized to make such decisions, and you must acknowledge these decisions could or would allow your death.

Q. Can I authorize my patient advocate to decide to withhold food and water administered through tubes?
A. Yes. If you wish to give your patient advocate power to have tube feeding withheld or withdrawn in the event you become terminally ill or permanently unconscious, you should state this in the document or in a living will.

Q. Must I have written instructions?
A. No, this is voluntary. However, written instructions are helpful because they show your choices for care. It is important for hospitals to understand your wishes. Writing them down makes it clear what you want. Or, you can simply make sure your family and caregivers know what you would want if you were to get sick.

Q. Must I make decisions now about my future medical treatment?
A. No. You do not need to have a durable power of attorney for healthcare, or a living will, and you do not have to tell anyone your wishes. You can still make treatment choices while you're competent. However, if you are no longer competent, but you've made sure your family and caregivers know what you would want, it will be easier to follow your wishes. If you haven't, a court may have to name a guardian to make decisions for you.

Q. If I write an advance directive, can I change my mind later?
A. Yes. You can change the document at any time. It is a good idea to review your advance directive each year to be sure it still says how you want to be treated and names an advocate you trust.

Q. What is a Durable Power of Attorney for Healthcare?
A. A Durable Power of Attorney for Healthcare is a legal document that allows you to name anyone at least 18 years of age to be your advocate and to make healthcare decisions for you, in the event you are unable. You can pick a family member, friend, or any other person you trust, but be sure the person you choose is willing to serve. It's wise to have a secondary advocate, in case the first advocate is not available.

Q. What is a "living will?"
A. A living will is a written statement in which you inform doctors and family members what type of medical care you wish to receive should you become terminally ill or permanently unconscious, and unable to make or communicate decisions about your continued care. A "living will" is not considered legally binding in Michigan.

Q. What might a living will say?
A. You might express your wishes in general terms- "Do whatever is necessary for my comfort, but nothing further." Or, "I authorize all measures be taken to prolong my life." You might express desires about the use of specific medical interventions, such as respirator, cardiopulmonary resuscitation (CPR), surgery and blood transfusions. You could authorize experimental or nontraditional treatment.You should express your wishes concerning food and water administered through tubes.

Q. Is a living will legally binding?
A. Although 45 states have laws giving living wills legal force, Michigan has not yet passed such a law. Doctors and hospitals might comply with your wishes, but no one can provide absolute assurance.

Q. Can I have both a durable power of attorney for healthcare and a living will?
A. Yes. You could have a single document or two separate documents. If they are separate writings, you should make sure your wishes expressed in the two writings are consistent. A "living will" should comply with the technical requirements of the durable power of attorney for healthcare.

Q. Are there issues I should give particular attention to?
A. Yes. Many people have strong feelings about the administration of food and water. If you are unable to swallow, food and water can be supplied by a tube down your throat, a tube placed surgically into your stomach, or intravenously. Consider in what circumstances, if any, you wish such procedures withheld or withdrawn.

Q. To have an advance directive, must I use the forms on this website?
A. Absolutely not. For instance, you may use a form put out by another organization, such as the State Bar of Michigan, Michigan State Medical Society, senior citizens' groups, or your state representative. You may hire a lawyer to draft the document or documents, or you may write the entire document yourself. If you write the entire document, type it or print so it is legible. In any event, any documents about your healthcare must be signed, dated, and witnessed by someone who has no vested interest in your healthcare. A friend, business associate, or spiritual leader would be appropriate choices.

Q. What are the technical requirements of a durable power of attorney for healthcare?
A. The declaration must be in writing, signed by you and witnessed by two adults. There must be a written acceptance by your patient advocate, in language set forth in the law. There are restrictions on who can be a witness, as indicated in the "Guide to Completing Michigan Durable Power of Attorney" included on this website. The link to this guide is in the window to the left

Q. What are the requirements for a living will?
A. Since there is no law, there are no formal requirements. It is strongly recommended, however, the document be entitled "LIVING WILL," be dated, signed by you and signed by two witnesses.

Q. What should I do with an advance directive after it is signed?
A. Give the original of a durable power of attorney for healthcare to the patient advocate (or at least make sure he or she knows where it is). Give a photostatic copy to your doctor, and keep the original copy for yourself. Keep the original in a locked, fireproof safe. Do not put your original copy in a bank deposit box. Give a copy to family members who are close to you, a friend, your doctor, and spiritual leader. Keep a list of these people. Have the doctor make the Advance Directive/Durable Power of Attorney part of your medical record. If you enter a hospital or nursing home, bring a copy of the form on each admission.