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Why Advance Directives Are Important

What are advance directives and why are they important.

"For the past few years, I've made a habit of giving advance directive forms to all of my new patients," says Dr. Karen R. Myers of Washington, D.C. "These are legal instructions everyone should take the time to complete.

"Myers, a doctor of Internal Medicine, knows firsthand the pain families suffer when terminal patients leave no care instructions. "I had a patient in his 40s who came into the hospital with pneumonia and meningitis," she says. "He turned out to have AIDS and just got sicker and sicker. Eventually, he slipped into a coma, and we pronounced him brain dead. But because he didn't have an advance directive, his family struggled with the decision of whether to let him go. Finally, after two months on life support, his poor body just couldn't take anymore. If the patient had made his wishes known in writing, his family could have been spared some of the heartache of losing him."

To keep this from being your own scenario, create a road map for your loved ones to follow. Put your desires in writing by completing three important documents: a living will, a health-care power of attorney, and a letter of instruction.

Why Create a Road Map?

Developing a road map keeps you in charge when it comes to decisions about medical treatment—even when you’re no longer capable of making those decisions. This kind of planning also shows compassion for family and friends. When loved ones are left guessing, too often the result is guilt, uncertainty, and arguments. By making your wishes known, you can help your loved ones feel more comfortable with your chosen course of care.

Parents' decisions about their own care usually, at some point, involve their children. When you complete your own advance directives, you have an opening to talk with your parents about whether they've made choices about their future medical care. Starting the conversation and learning what care they want can give the whole family peace of mind.

"I'm fortunate that my mother approaches me about her needs," says Carrie Dunson of Lee's Summit, Mo. "After my stepfather died in 1989, my mother and I sat down and talked about what she wanted as she grew older. We had our wills and advance directives drawn up at the same time and discovered that we want very different things. In the event of a coma, she wants doctors to do everything possible to revive her. But I don't want that for myself." 

What Do You Need?

Each of the documents you need for your road map serves a different purpose. The first two—living will and health-care power of attorney—are legal instructions known as advance directives.

A living will tells medical professionals and your family which medical treatments you want to receive or refuse—and under what conditions. It only goes into effect if you meet specific medical criteria and are unable to make decisions.

A health-care power of attorney allows you to appoint someone to make health-care decisions for you any time you're unable to do so. Most people choose trusted family members or friends who are comfortable talking to doctors. The power of attorney can also be referred to as a health-care proxy, an appointment of a health-care agent, or a durable power of attorney for health care. It is different than a regular durable power of attorney, which only covers financial matters.

The third part of the road map—a letter of instruction—isn't a legal document, but it helps families find important information and saves them from having to dig through papers during a crisis. This document is a three-part personal letter that goes with the will. The first part includes the names of people to contact and instructions for planning a funeral. The second part covers financial affairs such as lists of accounts and phone numbers for your employer, insurance agent, or broker. In the final part, you can give away meaningful possessions and write special messages to family members.

Taken together, the advance directive and letter of instruction give your family a road map for your wishes.

Getting Started

Consult an attorney for advice on the best way to tailor advance directives to your specific wishes, but you can find the components of your personal road map without ever leaving home. Even though advance directives are legal documents, it's not necessary for a lawyer to write them. If you would like to prepare your own, you can use our online resource to find forms specific to the state where you live.

Five Wishes, offered by Aging with Dignity, is a good model for advance directives. It's considered a legal advance directive in 42 states, and people in other states often use it as a starting point.

Since the letter of instruction is not a legal document, its contents are entirely up to you. If you need some help, AARP has suggestions for what to include in each section.

Seeking Guidance

An advantage of having an attorney draw up the documents is that you then automatically have someone to review them—now and in the future—with an eye to keeping them current if there are changes in regulations. Lawyers often charge fixed rates for preparing documents, so it should be fairly easy to find an affordable lawyer. You may also want to consult your health-care provider or another trusted source if you have questions about life-sustaining treatments or other medical terms found in the documents.  

What's Next?

Let family members know your wishes. Although it may be difficult or awkward to start the conversation, sharing your concern for your loved ones and communicating your beliefs and values can help set the right tone for the dialogue.

Keep a copy of your road map in a safe accessible place. Tell family members where to find it should an emergency arise.

Go over the road map with your designated health-care agent (named in your health-care power of attorney) and your back-up agent. Discuss any concerns, and make sure they have copies of all your documents.

Discuss advance directives with your doctor, and have a copy of them placed in your medical record. If your doctor seems uncomfortable following your wishes, consider changing health-care providers.

Review your road map every few years. These are tough decisions, and your views may shift as your health or circumstances change.

Planning for the unknown is never easy, but it's a gift to your loved ones. By having a road map, you can make sure you're comfortable no matter what direction your journey takes. 


For more information about planning for long-term care, visit Decide to plan now for long-term care, create a plan that works for you, and share it with your loved ones. Let AARP help you Decide. Create. Share.SM


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