An advance directive gives instructions about your health care, what you want done or not done, if you can’t speak for yourself. It’s called an advance directive because you choose your medical care before you become seriously ill. The minimum that any of us should have on file are a durable power of attorney for healthcare, a living will and a HIPAA release. The durable power of attorney for healthcare and living will are combined into one document described as an advance directive.


Many people suffer from chronic illness. For conditions that lead to loss of mental capacity, it is very important to have a designated person who can make medical decisions for you. If you are ever unable to reason or communicate, your designated advisor will discuss your medical care with doctors and hospital staff.

A durable power of attorney for healthcare allows you to choose a trusted person to speak to the doctors on your behalf. The person holding the durable power of attorney may be referred to as your “healthcare proxy”. This person may make medical decisions for you if required.


You should choose someone who understands your medical condition and your preferences about your care. This could be a family member or friend.

Adult children can be selected, but may experience great emotional trauma in making an end-of-life decision. A friend can be a good choice if there is not a child who feels willing or emotionally capable of making the decisions.

You should choose a healthcare proxy agent; and a successor to act on your behalf if your proxy is not available. If the proxy you have chosen is unable or unwilling to make decisions, he/she cannot designate another person. It is usually best not to select two persons as your proxy agent-they might disagree at a critical time while you are in need of an immediate decision.
If you do not have not appointed a healthcare proxy, and become incapacitated; a “surrogate” (or default decision maker) will be assigned. This person will usually be a family member and can make most medical decisions. They cannot however, decide to remove artificially administered nutrition, such as a feeding tube, that has been started. The decision to withhold or withdraw any other treatment can be made by a surrogate.


A person with chronic illness needs both a healthcare proxy agent and a living will. Your healthcare proxy agent can make decisions regarding your care, even if you are not near death. The function of the living will is to describe your preferences for care if you are potentially in your last weeks or days of life.

The advance of medical science has enabled doctors to keep people alive for extended periods of time, even if there is virtually no possibility of recovery. If you are in this circumstance, your living will provides guidance to your doctors.

For example, the living will can discuss whether or not heroic measures will be taken to sustain your life. If you have an irreversible condition with no chance of recovery, the living will also specifies whether nutrition and hydration will be maintained.

If you suffer from one of the chronic illnesses that affects mental capacity, it may be important for you to sign your living will before you have mental deterioration. Many Alzheimer’s patients and other individuals with great mental deterioration are no longer capable of signing a living will.


You may wish to have your medical information released to your professional advisors so they can make appropriate decisions for you. In order to receive this information, your healthcare proxy must have a formal release from you. If your advisor does not have a HIPAA release, the medical center may refuse to release your records to him or her.

The HIPAA release, which will be in writing, should describe the health information that may be released to the person. It may provide a general list of medical centers or providers or could have an open-ended release for any hospital or medical provider and may include a termination date. After you sign your HIPAA release, you can always revoke that release and sign a new one.

Any advance directive has no legal effect unless and until you lack the capacity to make healthcare decisions or to give consent for care. Neither the appointed health care proxy, nor written instruction can override your currently expressed choice.

If at any time you want to change or cancel any advance directive, tell your agent and/or healthcare provider in writing of your decision to do so. Destroy all copies of the old one, and create a new one. Make sure you give a copy of the new one to your physician and anyone else who received the old one. The most recent directive is the legally binding one.