Take the first steps in care planning with an advance directive
[5 min read]
In this article:
- Do your trusted loved ones know your wishes should you become incapactated by a an illness or in a health emergency or accident?
- An advance directive is a set of written instructions about your health care wishes at end-of-life or in an emergency.
- Completeing an advance directive relieves your family and loved ones of guesswork during a painful time and ensures that you recieve the care you do, and do not, want.
Nobody likes to think about a medical crisis, but if you become incapacitated and can’t speak for yourself, do your loved ones know what care or lifesaving measures you do and do not want? You can spare your family and loved ones the difficulty of making your health care decisions during an already painful time with an advance directive.
Advance directives are legal tools that let you share your healthcare wishes before an emergency or end-of-life, so decisions facing your loved ones in a health emergency reflect your values and provide clear guidance for your care team.
“The best time to complete an advance directive is before you ever need it,” says Peter Olson, M.D, an internist and System Chief of Medicine at Providence Swedish medical group. “I encourage every patient, regardless of age or health, to start the conversation with their primary care physician and to share the document with someone they trust.”
“Everyone should have one, regardless of age or health status. Accidents and sudden illness don't discriminate, and without an advance directive, critical decisions about your care may fall to others who are guessing at your wishes. Having one in place is an act of clarity and kindness toward both yourself and your loved ones,” says Dr. Olson.
An advance directive is a set of written instructions about your medical care if you become unable to make or communicate decisions. The two most common forms are a living will, which states what treatments you do or don’t want in certain situations, and a healthcare power of attorney (also called a healthcare proxy or agent designation), which names a trusted person to speak with clinicians and make decisions on your behalf. Washington state also uses POLST and ePOLST (Physician Orders for Life-Sustaining Treatment), which translate your current treatment wishes into actionable medical orders—especially important for people with serious illness or frailty. A POLST is completed with a clinician and is meant to complement (not replace) an advance directive.
Once you’ve completed the right forms, share copies with your primary care physician and close family members likely to be involved in your health care decision-making. It’s wise to keep your forms somewhere they’re easily found and to bring copies to the hospital if you’re admitted.
“In Washington State, physicians are legally and ethically obligated to honor a valid advance directive. The rare exception is if a requested intervention conflicts with a physician's personal or moral convictions, in which case they are obligated to facilitate a transfer of care,” says Dr. Olson. “But the far more common scenario is that an advance directive gives your care team the clarity they need to act decisively on your behalf.”
Your advance directive can be as broad or as detailed as you want. They commonly address:
- CPR and resuscitation preferences
- Use of a breathing machine (ventilator)
- Artificial nutrition and hydration (feeding tubes/IV fluids)
- Dialysis and other life-sustaining treatments
- Pain relief and comfort-focused care (including hospice)
- Where you prefer to receive care when possible (home, hospital, hospice facility)
- Organ and tissue donation and other after-death wishes (varies by form/state)
- Who should make decisions if you can’t, and any guidance you want to give that person
Advance directives protect your autonomy. They help ensure that treatment choices align with what matters to you—whether that’s pursuing every possible intervention or prioritizing comfort and quality of life.
“Medicine has become extraordinarily capable of sustaining life, but more intervention is not always the right intervention. An advance directive lets you define what ‘the right care’ means on your own terms, whether that is aggressive treatment or comfort-focused care. It shifts the conversation from what we can do to what you would want,” Dr. Olson affirms.
Without an advance directive, decisions typically fall to a spouse, adult child, parent or sibling. Families may disagree about what to do, which can lead to delays in care, and sometimes legal fights. Clinicians may also provide aggressive treatment by default when preferences are unknown.
“Your advance directive speaks for you when you cannot, and it takes legal precedence over family disagreement. Your physicians can and should discuss your care with family, and with your prior consent, share relevant information — but your documented wishes remain the guiding authority,” Dr. Olson emphasizes. “This is exactly why having a directive in writing matters so much.”
If you’re not sure where to begin, start with a conversation: think about what matters most to you in serious illness, choose a person you trust to be your healthcare agent and ask your primary care physician’s office for your state’s advance directive forms.
“I understand completely why someone would rather not think about an advance directive. I hear it from patients regularly, but my honest advice is that avoiding the conversation doesn't protect you from the situation, it just removes your voice from it,” Dr. Olson advises. “Think of an advance directive less as planning for death and more as protecting the life you want, on your own terms.”
More information about advance directives and downloadable forms in multiple languages are available at our website. Learn more today.
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