Healthy Living: Advance Directives 

By: Dr. Jonathan WoodWho needs an advance directive? Everyone.What is an advance directive? An advance directive is a document that clarifies your wishes about your own health care, should you be too ill or incapacitated to speak for yourself. Even more important, an advance directive can be used to name someone who knows your wishes (your “agent”) and will be thereby authorized to make health care decisions for you in such a situation.Aren’t these documents just for old people or chronically ill people? No. Advance directives are for everyone. In fact, much of the legislation surrounding this issue arose due to tragic medical cases involving young, previously healthy patients. Terri Schiavo. Nancy Cruzan. Karen Ann Quinlan. These are familiar names and all cases where national attention was brought to the issue of who should make medical decisions for those patients who are too ill to speak for themselves. These were young people in the prime of life before their illnesses. While these cases all involved dramatic “end of life” decisions, advance directives are designed to allow your wishes to be followed in any case where you are incapacitated, whether it is life threatening or not. Though we would rather not think about it, any of us could become critically ill or injured at any age. So, truly, all of us need some sort of advance directive.Is this a permanent document? No. An advance directive can be changed or revoked at any time. In fact, it should be updated periodically to be sure it still reflects your wishes. Look at the Maine Attorney General’s office website for more information on this point.Isn’t it difficult to anticipate every possible decision that might need to be made? It is not only difficult, it is impossible. While many people choose to outline their choices around a few common decisions regarding life-sustaining treatment (sometimes called a “living will”), most also choose to name an “agent” to speak for them in all the circumstances that are impossible to anticipate. An agent is sometimes referred to as your “power of attorney for health care.” Naming an agent who knows you well and knows your philosophies of life is an extremely important aspect of creating an advance directive. Specifically naming this agent is critical to having medical professionals act in your best interests while you are incapacitated. It also helps your family more easily and compassionately cope with your illness during such unfortunate events, which are often a time of great stress for your loved ones.What if my agent is unable to fulfill that duty? Typically, people name a list of several people who will be asked to step in if their first agent is unable or unwilling to act on their behalf. Considering this possibility can be an important part of creating your advance directive, but is not essential.Where do I find an advance directive form? Any signed statement, witnessed by two other people, will be accepted for naming a health care agent in the State of Maine. However, the best approach is to use an advance directive form created specifically for this purpose. One can be found in your primary care physician’s office, at any hospital, or at this website. Though the Maine form is long, only Part 1 needs to be filled out in order to name an agent. Part 6 needs to be completed as well, as this is where the signatures are placed (yours and your witnesses’). A notary is not required in Maine. However, to ensure that your advance directive will likely be accepted in other states, it is a good idea to have the signatures notarized, if possible.Advance directives are basic and necessary. With medicine’s increasing capacity to effectively treat critically ill patients, having a health care agent is essential to ensuring that your values, preferences, and wishes will be heard and followed.More information about advance directives can be found at the Maine Hospital Association website.