Common Questions: Advanced Directives

A living will, a terminal care document, a do-not-resuscitate order (DNR), Clinician Orders for Life-Sustaining Treatment (COLST), a healthcare proxy, or a durable power of attorney for health care… While the names can be confusing, each of these is an advanced directive you can use to reduce your loved one’s stress if you are no longer able to communicate medical decisions for yourself. Let’s review the most common questions.

Do I need advanced directives? Almost everyone can benefit from preparing documents that guide their family and healthcare professionals, in case they are unable to communicate their wishes directly.

What are the different kinds, and what are the differences between them? The different documents vary in their scope. 

• The Clinician Orders for Life-Sustaining Treatment (COLST) form includes a section that covers do-not-resuscitate orders. A DNR is a decision you make in collaboration with your doctor based on your health condition. Here in Vermont, doctors sometimes fill out only the DNR portion of the COLST for their patients.
• The COLST also allows you to share your preferences for other types of care. It includes questions about whether you would like mechanical assistance in breathing, to be transferred to another hospital, to receive antibiotics, and to be fed via a feeding tube and for how long, for instance.
• Living wills or advanced directives are the most comprehensive documents of their kind, as they include information found in DNRs, COLSTs, and more, including how you would like your relatives to handle your remains and which religious traditions you would like observed. Living wills make sense for all adults, regardless of their age and health.
• Perhaps most importantly, a living will includes an opportunity to appoint a healthcare proxy and or durable power of attorney for health care or an individual (and sometimes an alternate or co-designees) to make health decisions for you, if you can’t. You would discuss your decisions with your healthcare proxy, and they would have the decision-making power. For some, this is the only piece they would like to fill out.
• For Vermonters, I recommend this form from the Vermont Ethics Network.  People who live in New York can find their form here, while Massachusetts residents should use this one. In addition, Start the Conversation is a great website this is just a conversation guide but not specific to any state.

Do I need a lawyer to do this? No. Financial wills and health care wills are usually separate and for good reason. A lawyer can help with advanced directives, but their help is not necessary.

What if I don’t know what I want? Advanced directives communicate your personal sense of “how far is too far” when it comes to healthcare interventions. This line is unique to each person and can change based on your health and where you are in your life. These documents help you prevent others from inadvertently going farther than you would ever want. If you are not sure, you can take the document to your next doctor’s appointment to see if your physician thinks that your choices make sense in light of your current health.

What if I still don’t know? If you don’t know the answer to any of the individual questions, you can leave that question blank. You do not have to have all the answers for the document to work.

What if I change my mind?  It’s often helpful for people who are anxious about filling this out to know that the most current version of the document over rides all previous versions. So, you can make a decision this week, think better of it, and create a new document next week.

Is this too much stress for my family? Advanced directives actually help your family to have some peace of mind when making difficult decisions. They know that they are just carrying out your wishes, not taking charge and guessing about what you would want. It can also insulate family members from possible accusations from the extended family, who often don’t know the details of what is going on. The advanced directives show that these are the decisions you really wanted.   

Elizabeth Fredland, LICSW, is the oncology social worker at Southwestern Vermont Regional Cancer Center, part of Southwestern Vermont Medical Center and Southwestern Vermont Health Care in Bennington.