Coronavirus Pandemic: Understanding the Importance of Advance Directives

While its only human nature to want to avoid thinking about unpleasant subjects, it’s important to consider what would happen if you become unable to make decisions for yourself due to incapacity or illness, especially during the coronavirus pandemic.

What Is an Advance Directive?

An advance directive is a legally binding document that tells your doctor and caregivers what kind of care you want to receive if you become unable to make medical decisions. If this happens, making decisions about your care will be easier if you've previously identified someone to speak on your behalf and have expressed clear wishes about your care.

To make it clear for both your health care team and family members to understand, your advance directive outlines your wishes regarding life support, resuscitation and other interventions.

When Should I Make Advance Directives?

Some people make advance directives when they are diagnosed with a life-threatening illness and others put their wishes in writing while they are healthy. During the spread of COVID-19, the disease caused by coronavirus, it may be a wise choice to plan ahead now just in case, especially if you’re in what’s considered to be a higher risk category for severe illness from COVID-19.

How Does an Advance Directive Help My Loved Ones?

Too often, when loved ones are left guessing what should be done, the result is guilt, uncertainty and arguments. By making your wishes known ahead of time with an advance directive, you can help your loved ones feel more comfortable with your choice of care.

What Are the Types of Advance Directives?

There are two types of advance directives: a living will and a designation of health care surrogate form, also known as a durable power of attorney for health care. Both forms can be changed at any time, and it's a good idea to update them periodically.

What Is a Living Will?

A living will tells your medical team and your family what treatments you want to receive or refuse, and under which conditions. Your physician and your health care surrogate are required to follow all directives in a living will.

A living will is enacted only when your attending physician and a consulting physician determine that you're unable to make your own medical decisions and are unlikely to regain this ability, as well as being in a terminal persistent vegetative state, an end-stage condition, or in any other condition that you specified in your living will.

Is a Living Will the Same as a DNR?

A living will isn’t the same as a do-not-resuscitate (DNR) order, it is a separate document stating that you do not wish to be resuscitated if you experience cardiac or respiratory arrest. You’ll need to discuss your desire for a DNR with the attending physician so the order can be entered into your medical record. For the DNR form to be valid, it has to be completed by you and your physician.

Should I Designate a Health Care Surrogate?

The designation of health care surrogate, also called a durable power of attorney for health care, allows you to appoint someone to make decisions on your behalf if you're unable to do so. It's different than a regular durable power of attorney, which only covers financial matters. Also, it’s best if you appoint someone who knows your wishes and is willing and able to carry them out, especially about your personal, spiritual, moral and cultural beliefs.

If you're incapacitated, whether due to COVID-19 complications or otherwise, your health care surrogate will have the authority to make all medical decisions related to your health care. This includes decisions about when to withhold or withdraw life-prolonging procedures. The designation of a health care surrogate is active as soon as your physician deems that you're unable to make your own health care decisions.

Advance Directive FAQs

Many people ask, “Am I required to have an advance directive by law?” The answer is no, there's no legal requirement to have an advance directive. However, if you haven't made an advance directive, your health care decisions may be made for you by one of these people:

• A court-appointed guardian
• A close friend
• An adult relative
• Your spouse
• Your adult child
• Your adult sibling

The person making decisions for you may or may not be aware of your wishes. When you make an advance directive, discuss it with your loved ones so they're aware of your wishes.

If you want to write your own advance directive, downloadable forms may be found online through your state's health and human services website.

Getting Started With an Advance Directive

You and your loved ones can consult an attorney to offer advice on how to tailor advance directives that best meet your wishes. However, even though advance directives are legal documents, an attorney isn't required to write them. The only caveat is you must have two adults witness your directives, and only one of them can be a spouse or blood relative. Also, your designated health care surrogate cannot sign your advance directives.

Can I Change My Mind After I Write My Advance Directive?

Yes, you can change or cancel an advance directive at any time. Your changes should be written, signed and dated. In fact, it's a good idea to review your directives periodically and if changes are made, be sure to provide your primary care doctor with a new copy.

Your Next Steps After Creating an Advance Directive

Once you've created your advance directives, let members of your immediate family, especially your health care surrogate, know about them and where they're located.

You'll want to share a copy with your primary care doctor to include in your medical records and remember to provide a new copy if your directives change.

Be sure to also bring a copy of your advance directives with you when you're admitted to the hospital, whether or not it’s for COVID-19.

Here for You and Your Loved Ones

Planning for the future is never easy, but it’s especially important now as coronavirus continues to spread. Advance directives ensure your wishes are carried out if you become unable to make sound decisions about your health care and create peace of mind for both yourself and your loved ones. To learn more about coronavirus and find answers to frequently asked questions, visit our Coronavirus Resource Hub.