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How should I describe my healthcare wishes on advance directives?

There are two general lines of thought about the best way to specify wishes, and it’s really a matter of personal preference. The first way is just to state your general wishes without getting specific. For example, you might write “if there is no expectation of recovery, and I am suffering, I do not want to be kept alive by machines” or “I want everything possible done to keep me alive” or “I would want a two-week trial of life-sustaining measures if there is potential for recovery, after which if there is no recovery I would want these measures ceased.” Then you trust your health care agent to make the specific decisions that arise during the course of your treatment. Remember, the law has additional restrictions around nutrition and hydration, which means that unlike other things, your agent cannot make an assumption about what you would want, but has to follow your instructions. Therefore, even if you choose to state your wishes generally, you should include a statement regarding this which may be as general as, “My health care agent (and alternate agent [if applicable]) knows my wishes concerning artificial nutrition and hydration.” Then ensure you have had a conversation with your health care agent about these interventions. If your health care agent does not know your wishes regarding artificial hydration and nutrition, in general (but not always) medical providers will provide these interventions, which may happen even if your agent protests.

Here are some examples of what someone may write on a directive:

  • If I become terminally ill, I do/don’t want to receive the following types of treatments….
  • If I am in a coma or have little conscious understanding, with no expectation of recovery, then I do/don’t want the following types of treatments….
  • If I have brain damage or a brain disease that makes me unable to recognize people or speak, and there is no expectation that my condition will improve, I do/don’t want the following types of treatments….

These are just examples, and you should consider the different circumstances that would inform whether a treatment is right for you.

Another way to document your wishes is to specify explicitly what you would or would not want. It can be difficult to predict exactly what circumstances you will be in if you are ill and unable to communicate, so many professionals advise their clients to keep things simple and let their health care agent use their best judgment. However, some individuals feel strongly about whether they would want to receive certain types of interventions, in which case it can be important to write these wishes down in detail.

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