Advance Directives and Living Wills
Advance directive is the term applied to any expression of a person’s thoughts, wishes, or preferences for his or her end-of-life care. Most often advance directives provide instructions on limitation of care, including resuscitation from cardiac arrest. Advance directives can be based on conversations, written directives, living wills, or durable powers of attorney for health care. While still competent, the patient’s conversations with relatives, friends, or physicians are the most common form of advance directives. In the United States and some other countries the courts consider written advance directives more trustworthy than recollections of conversations. Following the advance directives of patients who have lost their decision-making capacity respects their autonomy and is widely recommended.
Legal precedents in the United States have held that an advance directive cannot be used to withhold life-sustaining treatment unless these conditions are met:
A surrogate has given authorization.
The patient has a terminal condition certified by 2 physicians or
The patient is in a persistent vegetative state certified by 2 physicians, including 1 with special expertise in evaluating cognitive function.