Advance Directives can be a confusing topic. Each country, state and province may have their own rules and regulations, and it is not always clear who should fill one out, and when. Our Advance Directives FAQ answers some of the most common questions people have about the topic.
Advance Directive FAQ – Everything You Need to Know
What is an Advance Directive?
An Advanced Directive is a simple form that gives a person a voice and say in their care even after they’ve lost the ability to speak for themselves. You can find out more by reading our article What is an Advance Directive?
Who should complete an Advance Directive?
Everyone should complete an Advance Directive. Because this form focuses on your wishes for care, anyone who is old enough to have an opinion should complete and register this simple form. You don’t need to have assets or an estate, because the Advance Directive is focused on your care not your stuff.
Do I need an Advance Directive even if I don’t have any major medical conditions?
Accidents can happen to anyone, so everyone needs an Advance Directive regardless of age or health status. It’s certainly important to have conversations with your loved ones, but as Virginia Morris says in her book Talking About Death, “a generic statement made in better times has little bearing on the complex and emotionally wrenching choices that arrive when a life is in the balance.”
If your loved ones have to make difficult decisions on your behalf, they’ll appreciate your clear, written instructions.
How much does it cost to complete an Advance Directive?
Unlike a Trust, Will or Estate document package which can easily cost thousands of dollars, an Advance Directive is completely free. You can choose to pay a small fee to register your Advance Directive with your state or a private registry companies, but it is not required.
I’ve completed my Advance Directive, how do I make sure my wishes are carried out?
Drafting an Advance Directive is just the first step in making sure your wishes are respected. You’ll also want to make sure the document is accessible if needed. At a minimum, you’ll want to provide a copy of the document to your agent, and keep a hard copy with your other important documents. You can ask your primary care doctor to keep a copy in your file and many HMOs or health management organizations will register a copy and remind you to occasionally review or update. You may also choose to register your Advance Directive with your state, find your state’s registry information or search your Secretary of State website.
An Advance Directive is a legally binding document in the US and Canada. That said, any document that is legally binding is also able to be appealed or fought. To ensure your wishes are followed when you are nearing death or not able to advocate for yourself, naming someone whom you trust and who understands your wishes as they are outlined, registering your documents with your state and/or healthcare provider and ensuring you have communicated clearly with your loved ones are excellent first steps.
Jump to Complete your Advance Directive in 3 Steps for detailed instructions.
Can an Advanced Directive be Challenged?
In rare cases, a situation may arise which causes your Advance Directive to be questioned or dismissed. In 2011, a study titled “Lost in Translation: The Unintended Consequences of Advance Directive Law on Clinical Care“(funded by the US Veteran’s Administration & the Pfizer Foundation), identified the five main reasons why Advance Directives are not enforced as “poor readability; health care agent restrictions; execution requirements (steps needed to make forms legally valid); inadequate reciprocity (acceptance of advance directives between states); and religious, cultural, and social inadequacies.”
Advance Directives are rarely challenged or dismissed, but it happens. Based on the five reasons above, the table below identifies potential challenges to an Advance Directive and steps to avoid that outcome.
How to Prevent an Advanced Directive from being Denied
|An Advance Directive may be challenged…||You can prevent this by…|
|…if the handwriting can’t be read. Whether the handwriting is illegible or there are notes in the margins that are cut off in a copy of the document, a medical practitioner in any state may choose to disregard all or part of the document if they feel they can’t fully understand the intent.||…writing clearly and keeping margins free from notations. Ensure the handwriting is legible to someone not familiar with your penmanship. If typed, initial each clause and avoid the temptation to make handwritten edits to a typed document.|
|…if the individual is incapable of understanding the form as it is written. Most state issued Advance Directives are written at a 12th-grade level or above, far above many individuals.||…finding a form that can be completely understood. An individual who has comprehension issues may choose to complete a simplified version of the form or complete a video recording. A list of foreign language versions is included below.|
|…if the document isn’t properly witnessed. States have different requirements for witnesses and though not all require notary stamps, most disallow beneficiaries, next of kin and medical service providers from acting as witness.||…understanding and following the requirements. Read the document carefully and check the state requirements. Seek guidance from a local legal aid organization or an attorney if there are any questions.|
|…if the document names a disqualified agent. Some states prohibit members of medical facilities or social service agencies from acting as agent which may impact an individual who doesn’t have friends or family they trust to act on their behalf.||…naming an eligible agent. If an acceptable agent cannot be identified, seek guidance from a local legal aid organization or social service office.|
|…if the state of residence has changed. When a person moves, the state where the document was first completed may or may not meet the requirements of the new state. Many states have reciprocity, but not all. A family in New York had to petition a judge to honor an Advance Directive that was executed in Pennsylvania after an elderly woman relocated to her daughter’s home to seek medical treatment.||…completing Advance Directives with identical information. It is possible to complete more than one Advance Directive, especially if there is a high likelihood for future relocation. If completing multiple state forms, do so on the same date using the same witnesses and provide the exact same information. Ensure there are no discrepancies.|
|…if specific requests are not accepted by the medical provider. If an Advance Directive contains requests that fall far outside the standard medical establishment procedures, doctors may not understand or accept the individuals wishes.||…completing an enhanced document and ensuring the team is in agreement. Seek legal counsel to obtain an enhanced documentation. Ensure the appropriate medical provider is in agreement with the document as written. If a family member may contest the wishes, address this directly.|
Are there Advance Directive resources for patients with dementia and/or Alzheimer’s?
Yes, preparing families and individuals for Alzheimer’s is a new and growing focus of end-of-life planning. As the worldwide population ages, the projected number of people living with dementia is expected to rise above 130 million by 2050, up from 47 million in 2015, nearly tripling in 35 years. Thankfully, there are organizations building tools to help ease the transition for those living with dementia. Some of those resources include:
- National Institute on Aging — Legal and Financial Planning for People with Alzheimer’s (en espanol)
- Compassion and Choices — Dementia Values & Priorities Tool
- On Point, NPR (podcast) — A Living Will for Alzheimer’s
- Alzheimer’s Association — End of Life Planning
Many of these resources are available for people who have recently been diagnosed or are experiencing mild dementia. Dr. Barak Gaster, creator of the Health Directive for Dementia, suggests a dementia-specific directive “ideally should be offered to patients before dementia occurs, as a supplement to a standard advance directive form.”
How can I encourage my loved ones to complete their Advance Directive?
Once you understand the value of an Advance Directive, you’ll want the important people in your life to complete theirs so you can be their best advocate if they ever need it. Beginning by sharing your reasons for completing your own Advance Directive is an excellent place to start.
It’s not always an easy conversation, but there are plenty of resources available. The Conversation Project offers conversation starters and tool kits to help families discuss end-of-life preparations. To find even more resources, including movie screening guides, printable brochures and conversation guides in multiple languages, visit Prepare for Your Care. The National Institute on Aging offers extensive articles and resources.
Discussing end-of-life wishes and medical advocacy can bring up big feelings and surprising responses. Take your time, be gentle with yourself and your loved ones and remember the reasons you want to explore this topic. Ideally, this isn’t a one-time discussion but a series of conversations. Reach out to your extended family, clergy or personal support network for guidance, if you need it.
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