Advance Directives

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

Key Messages:

  • Although it is difficult, talking about death and dying with your family and caregivers is important.
  • Along with this conversation, it also helps to create an advance directive, which outlines your wishes for the end of life.
  • There are two types of advance directives: a living will and a durable power of attorney for health care.

Discussing death and dying is difficult and sad for most people. But it is important for everyone, especially a person with advanced cancer, to revise and review his or her wishes for end of life care with family and health care professionals. Though it may be a difficult conversation, it ensures that your wishes will be known and followed, and it relieves your family members of the burden of trying to assume or guess what specific interventions and approach to your care that you would want. It reduces guilt and anxiety for decision makers if they need to make decisions for you when are no longer able to make these decisions yourself. An important step for many is to create, or perhaps make changes to, an advance directive.

An advance directive is a written set of instructions that explains the type of medical treatment you want and do not want if you become unable to make those decisions for yourself. An advance directive allows you to communicate your wishes to your family, friends, and health care team ahead of time to avoid confusion. You may also want to talk with your family and doctor about your wishes when making an advance directive to clarify your decisions and the values underlying them.

Making an advance directive

Any adult who is mentally and physically able to understand his or her medical condition and express preferences about their care can make an advance directive.

Although an advance directive can be oral (spoken) in most states, it is not recommended because it may require legal action to follow through with a person’s wishes. A written advance directive is the best way to communicate what you would like at the end of life.

Most, but not all, states honor an advance directive made in other states. However, if you move to another state, it is a good idea to complete a new advance directive. At this time, there is no advance directive form that is valid in all 50 states. Check your state's requirements and guidelines about advance directive documents. Caring Connections provides downloadable, state-specific advance directives.

Types of advance directives

Living will. This is a written set of instructions outlining your wishes about the type of medical care you may or may not want used to keep you alive. A living will can also be called a Directive to Physicians and Family. It is used when you have a life-limiting illness and can no longer communicate your wishes about medical care. A living will can include statements about:

  • Whether you want the medical team to use cardiopulmonary resuscitation (CPR) and/or artificial life support, such as mechanical respirators, if your breathing or heart stops. These are called CPR and do not resuscitate (DNR) orders. For a person with advanced cancer, CPR is rarely effective; talk with your doctor for additional information.
    • Whether you would want to receive a feeding tube (artificial nutrition and hydration), if you cannot be fed otherwise
    • Whether you want the doctors to perform certain procedures, such as kidney dialysis (a way to filter waste through a machine instead of the kidneys)

Living wills can be as detailed as needed to make sure that your wishes for treatments to keep you alive are followed. A living will can also include directions for donating your organs.

Durable power of attorney for health care. This type of advance directive designates a person that will make medical decisions for you if you become unable to make them yourself. The person you appoint is often referred to as your health care proxy, agent, or attorney-in-fact. This person can only make decisions about your medical care, not other matters, such as finances. Any competent adult, age 18 or older, can be a health care agent.

In addition, your health care agent can make decisions about your medical care after your doctor certifies in writing that you are no longer able to make your own decisions. Once you choose a health care agent, you can still make your own decisions about your medical care; your health care agent will only make decisions once you are unable to do so. It is important to talk with the person you are appointing as your health care agent so that he or she knows your wishes.

After completing your advance directive

It is important to remember that you can change your advance directive if needed. Changes are allowed as long as you still have or regain your ability to make decisions. You will need to notify your health care team if you make any changes.

You’ll also want to make sure that you and other people involved in decisions about your health care have up-to-date copies that are readily available. Copies should also be given to anywhere you receive treatment, such as a hospital, doctor's office, or nursing home, and you should also keep a copy in your home.

More Information

End-of-Life Care

Advanced Cancer Care Planning

Making Decisions About Cancer Treatment

When You and Your Family Differ on Treatment Choices

Additional Resources

National Cancer Institute: Advance Directives

Aging With Dignity: Voicing My Choices

Aging With Dignity: Five Choices

American Cancer Society: The Advance Health Care Directive

The Conversation Project

National Health Care Decisions Day

Everplans

OrganDonor.gov