Advance Directives

What is an advance directive?  It is a document that outlines people’s preferences for medical care when, in the future, they are unable to communicate their wishes.  It is particularly useful when someone is terminally ill, critically ill or has advanced Alzheimer’s disease.

LIVING WILLS

• This document contains written instructions in which people can describe which life-sustaining treatments they want and which they don’t want—if a time should come when they are no longer able to make decisions.
• Generally, a living will expresses someone’s wish not to be kept alive by artificial means—such as with a ventilator—if he or she is terminally ill or in a persistent vegetative state. 
• However, it is helpful to have additional written information attached to the living will that specifies what treatments are desired—and which are not.

HEALTH CARE POWER OR ATTORNEY

• A HCPOA is a legal document that names a particular person to be in charge of future medical decisions.  Many people choose their spouse or an adult child to serve as their health care power of attorney.  Other people choose a close family friend or even a lawyer.
• It is against the law for physicians or other health care employees to act as HCPOA for their patients.
• The idea is that the person named in a HCPOA will make the same decisions that the patient would have made if he or she were able.

YOUR ROLE IN ADVANCE DIRECTIVES

• If your clients have questions about advance directives, encourage them to talk to their physicians.  Also, let your supervisor know about any end-of-life discussion you have with a client.
• Remember...a nurse aide cannot officially be a witness for the signing of an advance directive.  If a client asks you to be a witness, explain that it’s against your workplace policy.
• Maintain confidentiality!  Keep information about your client’s advance directives to yourself.  Only coworkers who are working directly with a client need to know if the client has a living will or a DNR order.
• Be sure to notify your supervisor immediately if clients tell you they have changed their minds about their advance directives.  They have the right to cancel or change an advance directive at any time.
• Find out from your supervisor before you work with a client if he/she has advance directives or a DNR order.  Especially if you work in clients’ homes, you need to know what their end-of-life wishes are.