An advance directive is only for the elderly and other myths

August 11, 2020 in Health Risk Management  •  By Miles Varn, MD
advance directive

You may think of an advance directive as a document you only need once you’re in your 60s and 70s or when you’ve been diagnosed with a serious illness. In fact, it’s a good idea to create your advance directive when you’re young and healthy. The COVID-19 pandemic has highlighted the fact that anyone at any age can unexpectedly become seriously ill and be faced with decisions about what type of medical care they want. In addition, serious accidents, including car accidents and accidents that happen during activities like biking or playing sports or at work, can occur at any age.

The value of an advance directive is that it allows you to choose who you would like to make medical decisions on your behalf if you are not able to do so and indicate what types of medical care you do and do not want if you are seriously ill or injured. Even though awareness about advance directives has increased, a study found that only about a third of American adults has any type of advance directive for end-of-life care and more people age 65 or older have one compared to younger people.

Common myths about advance directives debunked

The low percentage of people with an advance directive can be partially explained by the fact that thinking about end-of-life wishes is difficult for many people and, for healthy young people, it may not seem like a pressing concern. But lack of understanding or myths about how an advance directive works and how it affects the care you receive also contribute to the low adoption rates. Here are some common myths and the facts about advance directives.

  • Having an advance directive means I don’t want to receive care if I’m seriously ill or injured. Some people confuse advance directives with do not resuscitate orders, which inform healthcare providers that you do not want CPR, mouth to mouth resuscitation, the use of a defibrillator, or intubation if your breathing or heart stop. An advance directive is more complex and outlines all your wishes about what types of medical treatment you do and do not want and under what circumstances your wishes should be followed. For example, you may want artificial nutrition and hydration even though you have advanced cancer, but you may not want it if you are in a coma and not expected to regain consciousness. In an advance directive, you also name a healthcare power of attorney or proxy. This person is authorized to make medical decisions on your behalf if you cannot.
  • By naming a healthcare power of attorney I give up the ability to make my own medical decisions. If you are ill or injured but are competent and can still speak for yourself, you remain the person who makes medical decisions. If choose not to make these decisions and ask your proxy to do so, you can override any decisions at any time or remove this person as your proxy and choose a new one.
  • Once I complete an advance directive, it can’t be changed. In fact, the opposite is true. You should review your advance directive regularly to make sure it still accurately expresses your wishes. The care decisions you make at 30 may no longer be want you want when you are in your 70s or are facing a terminal illness. In addition, you may want to change who you choose as your healthcare power of attorney. It’s recommended that you review and update your advance directive every decade, when your marital status changes, when you’re diagnosed with a serious illness, and when there is a decline in your health.
  • After I provide my advance directive to my doctor, my wishes will always be followed. In an ideal world, your advance directive would be shared by your primary care doctor with all specialists you see and would be part of a comprehensive medical record that’s accessed by treating physicians and hospitals in an emergency. Unfortunately, that’s often not the case. You should share your advance directive with all the physicians you see and your healthcare proxy should have a copy of the document that she or he can share with treating physicians in an emergency.