The term advance directive describes two types of legal documents that enable you to plan for and communicate your end-of-life issues in the event you are unable to communicate:

1. A living will allows you to document your wishes concerning medical treatments at the end of life.
2. A medical power of attorney (or health care proxy) allows you to appoint a person you trust as your health care agent (or surrogate decision maker), who is authorized to make medical decisions on your behalf.

Advance directives are legally valid throughout the United States. The laws governing advance directives vary from state to state, so it is important to complete and sign advance directives that comply with your state's law. Also, advance directives can have different titles in different states.

Living wills and medical powers of attorney are valuable tools to help communicate wishes about future medical care. Thoughtfully prepared advance directives can ease the burden on those who must make healthcare decisions for us.

Advance directives identify who you wish to speak for you and make decisions if you become unable to speak for yourself as the result of an accident or illness. Without advance directives, decisions might not be made by people who know you or your wishes. Advance directives give you a voice in decisions about your medical treatment, even if you are unconscious or too ill to communicate.

The above information is from the National Hospice and Palliative Care Organization. Click here to go to the website to download Advance Directives for your state: http://www.caringinfo.org/stateaddownload.

In the state of Illinois, there are three legally recognized advance directive documents. They include the Living Will, the Durable Power of Attorney for Healthcare and Five Wishes.

What is a Living Will?

A Living Will is a written directive made to your family, physicians and other health care providers expressing your wish to withhold or withdraw death-delaying medical treatment in the event of a terminal illness. It does not allow you do designate a health care agent to make health care decisions for you.

When does a Living Will take effect?

It becomes effective when a physician determines that you have a terminal condition, death is imminent and administering medical treatments will only prolong the dying process.

Can a doctor refuse to follow a patient’s Living Will?

A physician who cannot comply with the patient’s written directive for ethical or moral reasons must advise the patient and transfer care to another physician who will honor the patient’s wishes.

How can I best assure my wishes will be followed?

1. Use a form and follow procedures that meet State of Illinois requirements.
2. Give your physician(s) a copy, discuss its implications, and ask that it be placed in your medical record.
3. Have someone you trust keep a copy for easy access.

What is a Durable Power of Attorney for Health Care?

It is a written document granting a specified person (agent) the legal power to make health care decisions for you if and when you lack decisional capacity (when you become unable to make your own decisions) either temporarily or permanently.

What happens if my designated agent is unavailable, becomes incompetent or dies?

This may be avoided by naming other persons in descending order, who then assume responsibility for your decision-making.

Do I need a Durable Power of Attorney for Health Care if I have a Living Will?

It would be to your benefit. The Living Will takes effect only when you are diagnosed as having a terminal or irreversible condition. The Living Will does not allow you to designate an agent.v

What must I do to have a Durable Power of Attorney for Health Care?

1. Ask someone you trust to be your agent. Use a form and follow procedures that meet State of Illinois requirements.
2. Give copies to your agent, alternative agents, physician(s), health care providers, family members, lawyer, clergy member and any other person who is likely to become involved with your medical care.
3. Periodically review your directives to make sure it reflects your current beliefs, wishes and values. Revise as necessary.
4. While you may choose to seek the assistance of a lawyer to prepare this document, it is not necessary to be valid.

What is Five Wishes?

Five Wishes is an advance directive document created by the Commission on Aging with Dignity, a private, nonprofit organization founded by Jim Towey in 1996. The document is a large step forward in encouraging ay discussion of end-of-life choices. Ina gentle and non-threatening way, Five Wishes guides the process of making important health care decisions.

What makes Five Wishes different than other advance directives?

The print is large and readable. The text avoids technical legal and medical language. It explains life-support treatment and allows the individual to express care preferences. The second half of the document offers important guidance to family, health care professionals and pastoral care staff who wish to provide holistic care at the end of life. Five Wishes allows the individual to express his or her preferences for pain and symptom control and personal care. It also suggests to friends and family the ministry they can offer at the end of life, including music, touch and simple presence.

What are the Five Wishes in the document?

1. The person I want to make care decisions for me when I can’t
2. The kind of medical treatment I want or don’t want
3. How comfortable I want to be
4. How I want people to treat me
5. What I want my loved ones to know

How can I obtain a copy of Five Wishes?

To receive a copy of the Five Wishes document or to have a representative of Rainbow Hospice speak to your group, please call the LIFE Institute at 847-685-9900. Five Wishes can also be obtained online from Aging With Dignity.

When Writing an Advance Directive, Think about Your Medical Care

Often it is helpful to consider your feelings about certain types of treatment. For example - you do not want to be kept alive by a ventilator, what is it about ventilators that troubles you? Would it matter if you needed a ventilator for a few days, leading to recovery, rather than many months? While all situations cannot be anticipated, these questions may help you clarify your goals about your medical care.

What do I want medical treatment to accomplish?
Is it enough that treatment can prolong my life?
What is my definition of quality of life?
If life-sustaining treatment could not restore consciousness, would I want the treatment stopped?

Another way to become clear about goals for treatment is to consider your values.

How do I feel about my current health?
How important is independence in my life?
How do I imagine handling illness, disability, dying and death?
What kind of living environment is important to me if I am ill or disabled?
How much should expense to my family be considered when making a decision?
How might my personal religious beliefs play in my decisions?
What are my thoughts about life in general, my hopes and fears, my sorrows, and enjoyments?

What should I do once I have prepared an advance directive?

1. Review the advance directive document with your agent(s), physician(s), and your family;
2. Retain the original for safekeeping;
3. Give copies to your physician, health care providers, your family, your lawyer and anyone who would be among the first to come to you in a medical crisis;
4. Bring copies with you upon admission to the hospital or any other type of health care facility;
5. Keep documentation in your purse or wallet that you have an advance directive document and where it is located;
6. Review your advance directives every year or as your health status changes;
7. You may elect to update or revoke your advance directive at any time. Destroy all copies of your old advance directive documents, or write “revoked” in large letters on the copies you have. Tell your health care agent, family and physician that you have filled out a new advance directive. Make sure they have copies of the new document.

Five things people wish to communicate before death:
Forgive me, I forgive you, thank you, I love you, good bye

What else might a person want to plan?

What if I have not prepared an advance directive?

If you lack decision-making capacity and/or are unable to communicate your wishes, decisions regarding your health care will need to be made by someone else. The Illinois Health Care Surrogate Act permits a surrogate to make end-of-life treatment decisions on your behalf. The surrogate would be identified according to this hierarchy of relationships:

1. Guardian of the person
2. Spouse
3. Any adult children
4. Either parent
5. Any adult brother or sister
6. Any adult grandchildren
7. A close friend
8. Guardian of the estate