Combination Directives
A number of stater have a single advance directive statute that combines elements of a instructional directive, a DPAHC, and possibly a pain management directive into a single document. A combination document arguably avoids many of the pitfalls of each document alone. If the instructions are too general, the healthcare proxy has the authority to determine whether instructions should be applied under the specific circumstances. If the instructions are too specific and do not address the particular situation at hand, the healthcare proxy has the discretion to apply them or not. Nevertheless, a discussion between the patient and the healthcare proxy should occur regardless of whether there is a DPAHC or a combination directive. Communication is the most effective way to ensure that the patient's wishes are known and that the healthcare proxy is prepared to follow the patient's directives.