Advance Health Care Directive
An advance directive is a written, legal statement that lets your doctor, family, and others know your medical treatment preferences should you become unable to tell them. An advance directive appoints an individual as your agent and empowers them to communicate with your doctors and other medical staff so your health care wishes can be carried out.
Providing John Muir Health with Your Advance Directives
If you’ve already established your directives, you may include a copy in your health record with us by doing one of the following:
- Mail a signed copy to:
John Muir Health
Medical Records Department
1601 Ygnacio Valley Road
Walnut Creek, CA 94596
- Bring a signed copy to our office in the basement of the parking garage at the John Muir Medical Center, Walnut Creek.
Please make sure that there are valid signatures where necessary on the document. Also, include the full name, date of birth, and phone number where we can reach you on the document.
If you are coming in for a scheduled procedure or treatment, you may bring a copy of your advance directive with you to your pre-admission visit so it can be included in your health record at that time.
About Advance Directives
In California, there are two major sections involved in completing the standard form: Durable Power of Attorney and Individual Healthcare Instructions.
A Durable Power of Attorney for Health Care lets you name an agent to make decisions on your behalf. Your agent can make most medical decisions — not just those about life sustaining treatment — when you can't speak for yourself. You can also let your agent make decisions sooner, if you wish.
You can create an Individual Healthcare Instruction by writing down your wishes about the types of medical treatments you do and don’t want, or by talking with your doctor and asking her to record your wishes in your medical file. If you know when you would or would not want certain types of treatment, an Instruction provides a good way to make your wishes clear to your doctor and to anyone else who may be involved in deciding treatment on your behalf.
You may use these two types of Advance Directives together or separately.
How to Make an Advance Directive
You must be 18 years of age or older and capable of making your own medical decisions to make an advance directive. To get more information about making an advance directive, ask your doctor, nurse, social worker, or healthcare provider.
You do not need a lawyer, although you may want to consult one about the process. Each state has its own laws concerning advance directives.
State-specific forms are available online. The National Hospice and Palliative Care Organization has free downloadable forms on its website. You can also complete an advance directive E-1 form provided by the hospital.
After filling out the forms, make sure it’s easy for your loved ones to find your advance directive. Give copies to your doctor, the person you’ve chosen as your agent, family members, and friends.
When to Express Your Wishes About Health Care
It’s best to choose your agent and decide on the care you want before you get sick or have to go into a hospital, nursing home, or other healthcare facility. Choosing an agent and the kind of treatment you want in advance will help prevent confusion or disagreement about your wishes.
What Happens When You’re Admitted to the Hospital
If you don’t have an advance directive and you are admitted to one of our hospitals, we will ask you if you’d like more information about advance directives when you register. You will get medical treatment whether you have an advance directive or not but if you become too sick to make decisions, someone else will have to make them for you. If you’ve previously submitted a copy of an advance directive to us, we will use it to guide decisions about your care — unless you choose to give us a new one.
You Determine Your Treatment
Your doctor will tell you about your medical condition and about different treatments and pain management alternatives. Some treatments have side effects so you will want to work closely with your doctor to learn about potential reactions your body may have with various medical treatments.
Often, more than one treatment might help you. Your doctor can tell you which treatments are available to you, but your doctor can't choose for you. That choice is yours to make and depends on what is important to you.
Who Can Help Make Decisions
You can choose any adult that you trust to be your agent and to speak for you when healthcare decisions must be made. Patients often turn to their relatives and close friends to help them think through the choices they face. You can ask your doctors and nurses to talk with your relatives and friends about your health so everyone can better help you make decisions.
Selecting an Agent
The agent is the person you choose to make healthcare decisions on your behalf. Family, friends, and domestic partners may be the people you consider as agents in your advance directive.
It is helpful to talk to these people about your decisions before appointing them as agents. Discussing your decisions first is an opportunity to make sure the person you are choosing as your agent is able to respect your wishes without having personal beliefs or emotions prevent him or her from carrying out the responsibilities of the agent.
After you choose your agent, talk to that person about what you want in more detail. Sometimes treatment decisions are hard to make and it helps if your agent fully understands what you want. You should also write your wishes down in your advance directive.
It is best to talk to your agent periodically about your current health status and the choices you may face in the future. Get educated about your health issues and the treatments or procedures that your healthcare team may offer you.
As your health changes, review your advance directive to make sure it still reflects your wishes. Discuss your current health status with your agent and if you have different instructions about your health care, talk about these and revise them in your advance health care directive.
If you do not have family, friends, or others in your life that can be your agent, professionals are available to provide this service for a fee. In most communities a professional geriatric care manager is available through older adult service agencies and businesses, as well as private individuals who are qualified to fulfill the role of agent for the advance health care directive.
When an Agent Makes Decisions on Your Behalf
Usually a healthcare agent will make decisions only after you lose the ability to make them yourself. This can be a permanent state or a temporary condition. You can also state in the advance directive exactly when you want the agent to begin making decisions.
If you become too sick to make your decisions, the agent can step in at that point and make decisions for you. The same rules apply to anyone who makes healthcare decisions on your behalf. All are required to follow your advance directive or, if none, your general wishes about treatment, including stopping treatment. If your treatment wishes are not known, the agent must try to determine what is in your best interest.
The people providing your health care must follow the decisions of your agent unless a requested treatment is bad medical practice or ineffective in helping you. If this causes disagreement that cannot be worked out, the doctor must make a reasonable effort to find another doctor to take over your treatment.
Advance Directive Without Naming an Agent
You can still write out your wishes in your advance directive without naming an agent. You can say that you want to have your life continued as long as possible — or that you would not want treatment to continue your life. Also, you can express your wishes about the use of pain relief or any other type of medical treatment.
Changing or Canceling an Advance Directive
You can change or cancel your advance directive at any time as long as you can communicate your wishes. To change the person you want to make your healthcare decisions, you must sign a statement or tell the doctor in charge of your care.