Advance Directives for Health Care

Since the mid-1970s, much attention has been focused on the topic of advance or prospective health care planning. This activity has been promoted as a way for individuals to maintain some control over their future medical treatment even if they become physically and/or mentally unable to make and convey important decisions regarding issues of care. Advocates of advance health care planning also claim that it may help older persons and their families avoid court involvement in medical treatment decisions, conserve limited financial resources in a way that is consistent with patient autonomy or self-determination, and reduce the emotional or psychological burdens on families and friends in difficult crisis situations.

There are two main legal mechanisms available for use in prospective (i.e., before-the-fact) health care planning. One is the proxy directive, ordinarily in the form of a durable power of attorney (DPOA). This legal instrument names a proxy or agent who is authorized to make future medical decisions on behalf of the individual delegating the authority (namely, the principal or maker) in the event that the principal/maker later is unable to make decisions personally. The second legal device presently available for advance health care planning is the instruction directive, usually referred to as a living will, health care declaration, or natural death declaration.

In the United States, these legal mechanisms have their basis in various statutes enacted by state legislatures. In some other countries (e.g., England), advance directives have been recognized by the courts even though they have not been codified in the form of statutes.