Advance Directives Are Done: Now What?

Accessibility

Once completed, it’s very important to guarantee accessibility to your health care proxy and living will:

• Keep a copy in your wallet or purse
• Keep a copy of your advance directives for yourself in a secure place
• Do not put your advance directives in a safe deposit box or any other security box that would keep others from having access to them
• Give a copy of your advance directives to your health care agent and alternate agent, your primary care physician and/or nurse practitioner, all specialist physicians that participate in your care and the primary hospital where you receive care
• Share a copy of your advance directives with an electronic registry, if one exists
• Bring a copy if you are admitted to a hospital (even for minor surgery), if you undergo outpatient surgery or are admitted to a nursing home or long term care continuum.

Review and Update

What makes life worth living may change with the passage of time and different life experiences. For that reason, it’s also important to:

• Review and update your forms periodically
• Review after major life events like divorce, birth of a child, death of a spouse, as you may wish or need to choose a new health care agent
• Reevaluate your wishes if new life-threatening or chronic illnesses develop, as these chronic illnesses progress, and after complicated life-sustaining treatments, as your goals for care and wishes may change after these events

Avoid Problems

Be sure to talk to your health care agent, alternate agent, doctor(s), nurse practitioner, physician assistant, spiritual adviser, family and friends about your values, beliefs, goals for care and wishes concerning medical treatment. Discuss your wishes often, particularly if your medical condition changes.

Problems may arise if:

• you fail to plan
• you fail to have a conversation with your health care agent, your alternate agent, your family, your primary doctor/primary nurse practitioner, or your specialist doctors
• your goals for care or treatment change but these wishes are not reflected in your documented forms or shared with your loved ones

What if I Change My Mind?

You can always revoke your health care proxy and/or living will at any time.

If your wishes change after your documents have been completed, an entirely new set of documents reflecting your new wishes must be written, signed, and witnessed.

Give a new set of the documents to your health care agent and alternate agent, your primary care physician, nurse, physician assistant, and all specialist physicians that participate in your care and the primary hospital where you receive care.  These will replace the old version.

What Happens in an Emergency?

The standard of care is to provide all treatment to all people unless there is a medical order authorized by a physician or nurse practitioner to withhold life-sustaining treatment. Beginning in June 17, 2020, physician assistants will also be able to authorize such medical orders.

Your advance directives are not designed to be effective in the event of a medical emergency. Advance directives provide direction for future medical care in the event the person is unable to make medical decisions.

Ambulance personnel and all health care professionals are required to provide cardiopulmonary resuscitation (CPR) and all other life-sustaining treatment, unless they have a specific medical order to withhold treatment.  In New York, medical orders to withhold CPR and other life-sustaining treatment are recorded on the Medical Orders for Life-Sustaining Treatment (MOLST), a New York State Department of Health form that is recognized in all settings.