Background on Advance Directives


Alternatives for Life-Affirming Advance Directives



Background on Advance Directives

Based on the passage of the Patient Self-Determination Act in the Budget Reconciliation Act of 1990, the advance directive has been established by law.  As of December 1, 1991, every adult patient entering any health care facility receiving Federal funds is likely to be questioned about whether they have signed an advance directive (either a “durable power of attorney for health care” or a “living will”).

Patients are not required to have or complete one of these documents to enter a health care facility, but the law requires they be offered the opportunity to complete such a document.  It is not a good idea to make any quick decisions, so declining to sign any advance directive under such circumstances is highly recommended.

Each state has created a standard form “durable power of attorney for health care” and “living will.”  If you do not encounter advance directive forms at a health care facility, you will likely be encouraged to complete an advance directive when you go to an attorney to prepare a will or for estate planning.  Most attorneys will offer the standard advance directive forms available in their state, but these are not the best forms to use.

A common concern is that attorneys encourage completion of both a “durable power of attorney for health care” (DPAHC) and a “living will.”  The DPAHC is a more effective document to use because it allows the designation of an agent who can make health care decisions for you when you cannot.  The living will is more generic and allows the treating doctor to interpret the meaning of its provisions without any input from a designated advocate. You can learn more about the dangers of living wills here.

Pro-life Healthcare Alliance (PHA) strongly suggests that you avoid signing a living will in all cases because it is a poor substitute for the DPAHC, and completing both documents can create confusion.

In the current medical and legal climate that is trending toward promotion of euthanasia and assisted suicide for the disabled and terminally ill, PHA endorses use of a life-affirming version of the DPAHC, rather than the standard state version.  Some life-affirming DPAHC options are listed at the beginning of this article.

Even with a life-affirming DPAHC, it is still critical that you name someone you can trust to make the correct decisions regarding your healthcare choices when you cannot, usually a family member or close friend.  It is extremely important to confirm that your selected agent agrees with your perspective on end of life issues rather than, for example, choosing your oldest child by default.  Additionally, there is no substitute for a competent physician, faithful to the Hippocratic ethic and tradition, as the prime protector of the rights of the terminally ill and the incompetent disabled.  If problems exist here, contact PHA to seek a help through our referral network.

Original copies of your completed DPAHC should be provided to your agent(s), and might also be given to your physician, or healthcare institution, at your discretion.