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Advance Directive

Who will speak for you if you can no longer speak for yourself?

An advance healthcare directive tells your doctor and your family what kind of care you would like to have if you are unable to make medical decisions.

When you are healthy, it's hard to think about the care you want if you become ill or are facing the end of your life. You should prepare this while you're healthy and thinking clearly, as it is important. It is best to complete this before a medical crisis.

An advance healthcare directive will relieve your family's stress. Knowing your wishes keeps them from struggling on their own about what you would like to have done. It keeps them from disagreeing about the best course of action.

Things To Know

  • It's not just for older people. It is important for young people too, as they could be kept alive for decades in a condition they would not want.
  • Advance healthcare directives aren't synonymous with "don't treat." Some people choose only to have their pain controlled when death is near; others want all possible treatments. It is your opportunity to let your family and physician know of your wishes.
  • You do not give up control of your healthcare decisions. Only when you are unable to communicate will the advance healthcare directive be followed.
  • You do not need a lawyer to make an advance healthcare directive.
  • You do not need a specific form. You can write your wishes down yourself. It has to include your signature and date and the signatures of two qualified witnesses. 
  • It does not have to be notarized. Witnessed by two people is sufficient.
  • Your wishes do not have to be in writing, but it is very helpful if they are.
  • You do not have to have a surrogate decision-maker, but it is recommended. A surrogate decision-maker is someone you have chosen to make decisions for you if you are unable to make them for yourself. 
  • Doctors and hospitals are obligated to follow your advance healthcare directive. In order to follow it, your physician and hospital must be aware of it. It is up to you to ensure that everyone who might need a copy of your advance healthcare directive has one.
  • If emergency medical services are called to any location outside an acute care hospital (such as your home or healthcare facility), they are required to resuscitate and stabilize patients until safely in a hospital. If you do not wish to have cardiopulmonary resuscitation (CPR), you must have a special "pre-hospital do-not-resuscitate" form. This form, which has to be signed by your doctor, protects you from having CPR.
  • Carry identification that includes where to easily obtain a copy of your advance healthcare directive.
  • Keep a ready copy of your advance healthcare directive at home along with a current list of medications and health conditions.
  • If you live in a skilled nursing facility or nursing home, the long-term care ombudsman, or patient advocate, is required to witness your signature on your advance healthcare directive.

How to Create an Advance Directive

  • Start with your doctor. Discuss the types of medical problems you may face based on your health and history. Your doctor can help you understand the treatment choices.
  • Think about your goals for medical treatment. It is impossible to plan for every medical event, but you can make your preferences for medical treatment clear.
  • Identify the quality of life you find acceptable.
  • Pick someone you trust to be your surrogate decision-maker. This should be someone who would be able to make tough decisions, who would speak up in a crisis situation, who understands your desires and who would speak for you when you are unable to speak for yourself.
  • If you choose more than 1 decision-maker, designate who will be 1st and who will be 2nd. You should have at least 1 alternate person, in case the 1st person is unavailable.
  • You can indicate if there is someone whom you do not want to make your decisions for you.
  • If there are medical treatments you do not want under any circumstances, make that very clear. You have the right to refuse any medical treatment or surgery.
  • If you do not agree with the language in a pre-made form, change the language. Sign a form only after you are certain that it truly reflects your specific wishes.
  • You can write your wishes in your own words, but you have to be certain they can be clearly understood by others. You may want to go over this with your doctor to be certain medical care providers can understand your wishes. As long as your wishes comply with the law, they will be followed.
  • Discuss your wishes with your surrogate decision-maker, your family and your doctor.
  • Sign the document in the presence of someone who is not your decision-maker; is not related to you by blood, marriage or adoption; will not benefit from your estate; or is not your healthcare provider. An unrelated friend, neighbor or minister make ideal witnesses.
  • Be certain your wishes and instructions are clearly understood by all.
  • If you have a local hospital, give a copy of your advance healthcare directive for their files.
  • Give a copy to your physician and surrogate decision-maker.

Can You Change Your Mind?

Absolutely!

  • In writing, tell your surrogate and your physician.
  • Destroy all the copies of the old one, and create a new one.
  • Be sure a give a copy of the new one to your physician, surrogate and hospital.
  • The advance healthcare directive with the most recent date is the legal one, and this is the one that will be followed.
  • If you do not have time to put your changes in writing, tell your doctor, family and friends who are present exactly what you want to happen. Wishes that are made in person will be followed in place of the ones made earlier in writing.

If You Do Not Have an Advance Directive

Decision-making is left to someone else, generally a family member in order of kinship. This means decisions may be made by someone you may not have chosen. An advance directive can give you peace of mind and will be appreciated by those caring for you and those who care about you.

Another option that may be helpful is the Physician Orders for Life-Sustaining Treatment (POLST). It is based on effective communication of patient wishes, documentation of medical orders, and a promise by healthcare professionals to honor these wishes. Please discuss this with your physician.

Education for Life's Issues

The mission of the Education for Life's Issues program (ELI) is through community education, to empower individuals to make informed decisions about the end of life and other healthcare issues.

ELI is a community education program of San Gorgonio Memorial Hospital, in partnership with the California Coalition for Compassionate Care.

ELI Speakers Bureau

Through community education we demystify these issues, allowing seniors and their families to feel empowered and in control, ultimately living more satisfying lives.

Speakers are available to address your community group or employees on a variety of topics that include:

  • Advance directives for healthcare
  • Hospice and palliative (comfort) care
  • LIVE campaign: It's About How You Live
  • Becoming a community partner
  • Various end-of-life and other healthcare-related issues

Humor and audience participation are used. We make it fun to learn about what is perceived as a difficult issue, and there is never a dumb question. It's about how you live!

ELI Quiz

Take this readiness quiz. Give yourself 10 points for each "yes" answer.

    1. I have made my healthcare wishes known in writing, and there is someone who can get to this document today if I could not.
    2. I have my healthcare wishes in writing, and my primary care physician has a copy and we have discussed this.
    3. I have discussed my healthcare wishes with my family, friend or significant other.
    4. I have a trust and/or a will, and I have someone who can get access to it today if I could not.
    5. I have a plan for when I can no longer take care of myself in my own home.
    6. I have a current list of all of my medications and medical history in my wallet or purse and ready in my home if needed.
    7. I have a designated person or persons to make decisions for me if I were not able to do so.
    8. I have a financial plan to take care of myself for as long as I expect to live.
    9. I have someone to call or check up on me daily.
    10. I understand my current medical condition(s) and am comfortable discussing them with my healthcare provider.

To calculate your total score, give yourself 10 points for each "yes" answer.

How Ready Are You?

100: Very good! You are ready; keep your plans current.
80 to 90: Good, just keep your plans current.
70 or below: Work on your plan!

Contact ELI

For more information, to schedule a presentation for your group or to get involved, please call the foundation office at 951-769-2137 or email us at tim.harned@vna-ic.org.

Donate to ELI

All donations may be directed to the SGMH Foundation and designated for "ELI."