An Advanced directive is a legal document that a patient completes, designating 1-3 individuals who can function as their decision maker should they become incapacitated (for example while undergoing surgery, infection, mind altering medications or severe disease states). The patient can designate that this document is valid for a set period of time or for their lifetime. They also can designate whether their surrogate can make decisions on their behalf or whether they are only to carry out their wishes as detailed in the document. The directive usually addresses specific circumstances to consider. It is best to discuss with your physicians how your specific disease is likely to behave over time to guide those choices.
Picking a healthcare proxy, also known as a surrogate decision maker, is one of the most important decisions anyone can make. Ideally, you and this person (or persons depending on your wishes and state of residence) will be someone who knows YOU extremely well. Having thoughtful conversations about what matters to you most, what quality of life means to you and under what circumstances you might not want invasive interventions is important so that the proxy can represent your wishes. The surrogate does NOT have to be a family member. Sometimes instead of a family member, patients prefer to identify someone very close to them who has the ability to manage highly emotions and complex information. Medical crises can be overwhelming and cool heads prevailing guided by clear instructions can make a challenging time less stressful.
Anything that is a concern for you and your family should be considered. It is important to understand that your patient experience is unique to you. Palliative teams focus on clarifying what your hopes and dreams are in the context of your llness to ensure this information is conveyed to your medical providers. Considering the most likely, probable, and less likely events to occur, helps to guide discussions about which treatment options you feel most comfortable pursuing and that are in line with your goals. Advance care directives will likely evolve over time. Decisions made today may need to be adjusted as your treatment paths evolve. Your voice is the most important voice in the conversation as the plans are created so that the team and your proxy can represent you should you be unable to do in the future.
Advance directives and physician/medical orders for life-sustaining treatment (POLST or MOLST) forms go hand in hand for guiding your care and ensuring your wishes are
POLST gives seriously ill or frail people more specific direction over their health care treatments compared to advance directives and more options than Do Not Resuscitate (DNR) order.