Advanced directives are written documents that tell your physician and your family about your wishes regarding the health care you want to receive if you are no longer able to make these decisions for yourself. There are really two types of advanced directives: a "Living Will" and a "Durable Power of Attorney for Health Care". You may choose to have both, neither, or one of these two types of advanced directives.

If your health deteriorates to the point that you are no longer competent to make health care decisions for yourself, your doctor will consult with your family to decide what treatments to use, when to treat and when to stop treatment. Sometimes your family will not know your feelings about how you would want modern medical technology to be used if you have a condition where your chances of recovery are very low. In addition, there can be a great deal of strife amongst your family members when there is disagreement about how much medical technology to permit when your prognosis might be poor. Advanced directives reduce the occurrence of these problems by making your wishes clearly known and helping guide your family in confidently abiding in your wishes.

A "Living Will" is a document directing your physician that certain life-sustaining procedures should be withheld or withdrawn if you have a terminal condition.

A life-sustaining procedure includes any mechanical or artificial means that sustains a vital bodily function and would only prolong the dying process. A mechanical ventilator is a good example of a life-sustaining procedure.

A terminal condition is an irreversible condition that is likely to lead to death in a relatively short period of time or will result in permanent unconsciousness from which there is little hope of recovery.

A "Living Will" only takes affect when you have a terminal condition AND you are no longer able to make decisions for yourself.

A "Durable Power of Attorney for Health Care" is a document in which you name another person (your "health care agent") to make health care decisions for you when you are no longer able to make them for yourself. If you have not documented your specific requests (see "What is a Living Will" above), your health care agent will make decisions for you in your best interests. Unlike a "Living Will" (which only applies to terminal conditions), a "Durable Power of Attorney for Health Care" appoints a person to make any health care decisions for you whenever you are unable to answer for yourself. If you want to limit the scope of your health care agent's authority, you simply need to outline your restrictions in the "Durable Power of Attorney for Health Care" document. The person you name as your "Durable Power of Attorney for Health Care" should be someone you trust as well as someone who has agreed to act in this capacity for you. Your "Durable Power of Attorney for Health Care" cannot be your doctor, nurse or any other person providing for your health care (or any of your health care team's employees, unless the employee is your close relative). In addition, you should name an alternate person if the person you have chosen as your health care agent is not able to serve in this capacity when you need it. You should talk to your health care agent now and make sure this person knows your wishes.

Through a "Durable Power of Attorney for Health Care", your health care agent can answer all your health care concerns, including issues normally outlined in "Living Will". Remember, a "Durable Power of Attorney for Health Care" is instructed to make all health care decisions for you when you are unable to make theses decisions for yourself, regardless of whether or not you have a terminal condition. A "Living Will" only applies when you have a terminal condition. Therefore, if a person only wanted one type of advanced directive, the "Durable Power of Attorney for Health Care" has a broader scope. Nevertheless, many people choose to have both forms of advanced directives. There are many difficult ethical dilemmas that arise when making health care decisions for you if you have a terminal condition. It is easier for the person you choose as your "Power of Attorney for Health Care" to make these decisions when you have already spelled them out in your "Living Will".

Different states have different rules but in Iowa, a lawyer is not required for a legal and enforceable advanced directive. Nevertheless, many people prefer to have a lawyer involved so that they are more confident that the advanced directive is serving its intended purpose. Forms for completing advanced directives are available from your physician at Dubuque Internal Medicine. These forms were developed by the Iowa State Bar Association. If you live in another state, contact your state bar association or state medical society for the appropriate forms. The form must be completed, dated and signed. Your signature must be:

• witnessed by two people over the age of 18

OR

• notarized (if you use a notary, you do not need any witnesses).

Your health care agent (on a "Durable Power of Attorney for Health Care") or any one of your health care providers cannot serve as witnesses. At least one witness must not be related to you by blood or marriage.

Put the original document(s) in a safe but readily accessible location. Let people know where you have placed your document(s). A safety deposit box is NOT a good storage location. You should provide copies to your relatives, your attorney (if you have one), your physician, your health care agent/alternate (if you have one) and your local hospital.

An advanced directive can be changed or revoked at any time, regardless of your mental or physical condition. You need to inform your physician any time you change or revoke your advanced directive.