What Should Be Included in an Advance Directive?

Planning for the future can feel intimidating, especially when it involves considering scenarios where you're unable to make your own healthcare decisions. This is where an advance directive becomes invaluable. It’s a legal document that outlines your wishes regarding medical care should you become incapacitated. 

As an elder law and estate planning attorney in Oakland, California, I often see the peace of mind that comes with having these crucial documents in place. When you team up with the Law Offices of Gary R. Kershner, I can help you understand what you should include in your advance directive so you can prioritize your needs and protect your future.

What Is an Advance Directive?

An advance directive is a legal tool that allows you to express your healthcare wishes in advance.

In California, the most common type of advance directive is the Advance Health Care Directive. It lets you appoint a healthcare agent to make medical decisions for you if you can’t.

Having an advance directive in place with the help of an estate planning attorney relieves the burden from your loved ones during a difficult time, and it helps allow your medical care to align with your values.

Key Components of an Advance Health Care Directive

A comprehensive Advance Health Care Directive should encompass several key elements. Let's break down what you should include:

• Appointment of a healthcare agent: This is arguably the most important part of your directive. Your healthcare agent is the person you trust to make medical decisions for you when you're unable to communicate your own wishes.

Choosing the right healthcare agent is crucial. Consider these factors when making your selection:

• How well does this person understand your values and beliefs regarding medical treatment?

• Are they comfortable asking tough questions and advocating for your wishes, even if it means disagreeing with medical professionals?

•  Are they likely to remain calm and composed under pressure?

• Are they geographically close enough to be readily available if needed?

It's also wise to name an alternate agent. This makes sure that if your primary agent is unavailable or unwilling to serve, you still have someone you trust to make decisions for you.

• Statement of healthcare wishes: This section allows you to detail your preferences regarding various medical treatments. Be as specific as you feel comfortable being with your estate planning attorney. While you can't anticipate every possible scenario, you can address common situations:

  • Life-sustaining treatment: This includes interventions like CPR, mechanical ventilation, and artificial nutrition and hydration. Do you want these treatments withheld or withdrawn under certain circumstances?

  • Pain management: How important is it to you to receive pain relief, even if it might hasten your death?

  • Resuscitation: Do you want to receive CPR if your heart stops beating?

  • Artificial nutrition and hydration: Under what circumstances would you want or not want to receive nutrition and hydration through a feeding tube or IV?

  • Mental health treatment: You can express your preferences for mental health care, including medication and therapy.

  • End-of-life care: Where do you prefer to spend your final days? Do you have any specific requests regarding comfort care?

  • Organ and tissue donation: Do you wish to donate your organs and tissues after your death?

These preferences offer guidance to your healthcare agent and medical professionals. Clearly articulating your wishes with the guidance of an estate planning attorney minimizes confusion and allows your care to align with your values.

• Effectiveness of the directive: Clearly state when your advance directive goes into effect. Typically, it becomes effective when you’re no longer able to make your own healthcare decisions. This is often determined by your physician.

This provision clarifies the circumstances under which your agent can act on your behalf. It avoids any ambiguity about when the directive becomes active.

• Guardianship designation (Optional): If you anticipate the possibility of needing a guardian for other matters, such as financial decisions, you can include a designation in your advance directive.

This is a separate matter from healthcare decisions, but it can be addressed in the same document for convenience. It makes sure that someone you trust can manage your affairs if you become incapacitated.

• HIPAA release: Work with your estate planning attorney to include a HIPAA release to allow your healthcare agent to access your medical records. Without this release, medical providers may be restricted in what information they can share, even with your designated agent.

This release is essential for your agent to effectively advocate for your healthcare. It removes privacy barriers that could hinder their ability to access necessary information.

Considerations for Specific Situations

While the core components outlined above are essential, there are some additional considerations you should mention to your estate planning attorney depending on your circumstances:

• Pregnancy: If you’re a woman of childbearing age, you may want to address your wishes regarding medical treatment during pregnancy.

• Chronic conditions: If you have a chronic condition, such as dementia or a terminal illness, you may want to include specific instructions related to the management of that condition.

• Religious beliefs: If your religious beliefs influence your healthcare decisions, be sure to document them in your advance directive.

These specific considerations allow you to tailor your advance directive to your unique needs and circumstances. They make sure that your wishes are respected in a variety of situations.

Making Your Wishes Known

Creating the document with an estate planning attorney is just the first step. It's equally important to make your wishes known to the relevant parties:

• Discuss your directive with your healthcare agent: Have an open and honest conversation with your agent about your values and preferences. Make sure they understand your wishes and are comfortable carrying them out.

• Provide copies to your healthcare providers: Give a copy of your advance directive to your primary care physician and any other healthcare providers you see regularly.

• Keep the original document in a safe place: Store the original document in a safe and accessible location. Let your healthcare agent and other trusted individuals know where it is. You might also consider registering your advance directive with a registry service, if available in your area.

Communicating your wishes and allowing access to your directive is vital for its effectiveness. These steps allow for your healthcare providers and loved ones to be aware of your preferences.

Review and Update Regularly

Your advance directive isn't a "set it and forget it" document. It's important to review and update it periodically, especially if you experience any significant life changes, such as a marriage, divorce, birth, or diagnosis of a serious illness. Regularly revisiting your directive allows you to make any necessary adjustments and allows it to continue to reflect your current wishes.

Regular review and updates keep your advance directive relevant and reflective of your current healthcare preferences. Life changes often prompt a reevaluation of priorities and wishes.

Contact an Estate Planning Attorney Today

Don’t delay in getting this important document in place. Reach out to me today at the Law Office of Gary R. Kershner. I serve clients in Oakland, California, and throughout the Bay Area including Berkeley, Alameda, Emeryville, Rockridge, Piedmont, Fruitvale, Fremont, San Jose, San Francisco, and beyond. Call today for a free, in-depth consultation.