Advance Medical Directives (AMDs)

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Advance Medical Directives (AMDs)

These documents address a variety of complicated medical, legal and ethical situations that may confront each of us—and our families—at times of decision-making incapacity during medical emergencies or near the end of life. Although there is considerable variation among them, every state recognizes the patient’s right to make fundamental choices as to the care and treatment he or she will or will not receive at that time. AMDs go by a variety of names in different places: the living will and health care power of attorney are common.

Your consent needed

In all cases—whether you have signed an advance medical directive or not—as long as you retain the capacity to make and express decisions for yourself, your consent must be obtained for your medical treatment. You remain solely and totally in control. If you have an AMD, it can be revoked or modified at any time, if you are still capable of doing so.

There are three distinct, fundamental questions to be addressed by your AMD:

• What should be done or not done when death is imminent?
• What should be done or not done if you fall into a coma or similar state, when death is not imminent but there is no reasonable chance of recovery?
• Who will be your medical decision-maker (or surrogate or proxy) if you become unable to intelligently make and communicate decisions for yourself?

There are also two practical matters that it’s wise to deal with in your AMD:

• Your decision-maker should be authorized to make contracts on your behalf for any healthcare-related service or facility.
• Your decision-maker should be authorized to have the same access to medical records and information that you are entitled to.

What format?

No specific format is required of an AMD in most places. In fact, most states have laws that include a sample form for appointing a health care proxy, and/or for creating a comprehensive advance directive, so you don’t need a lawyer. In many states, the use of these forms is optional, or they need only be "substantially" followed. Since it is a simple document, if you do choose to have a lawyer prepare your AMD, it should not cost much, especially if it is done at the same time as your will or trust.

A word about signing your AMD is in order. Required procedures for signing and witnessing an AMD vary widely—that’s one reason a state-specific form is best.

Who is a valid witness to your AMD?

Perhaps most importantly, however, keep in mind that under the law of some states, the following people, who might be at your side during a grave illness, might not be valid witnesses to the document signing, even though they are allowed to be your decision-maker:

• Your treating physician, health care provider, health facility operator, or even an employee of any of these
• Anyone related to you by blood or adoption
• Anyone entitled to any part of your estate under an existing will or by operation of law (this would rule out one’s spouse).

CaringInfo, a program of the National Hospice and Palliative Care Organization (NHPCO), is a national initiative to improve care at the end of life. You can access a state-specific AMD along with instructions and guidance at http://www.caringinfo.org.