Living Wills, Advance Directives and Medical Power of Attorney – What’s the difference?

When working with people on estate plans, I always encourage them to make sure they have up-to-date documents to instruct doctors and family member of what they want to happen if they are so seriously ill they cannot speak for themselves.  Most people have heard of living wills, typically documents that give instructions about the use of life support for a person who is not expected to regain consciousness.   Some people feel strongly that they do not want to ever be on life support, others prefer to extend life for as long as possible.  This is a highly personal decision, and it is a blessing to family members to have a written document to refer to so they know your wishes.

An advance directive is like a living will, but it covers a much broader range of situations.  When a patient is very ill, they may be unable to make medical decisions for themselves, even if they are not unconscious or on life support.  An elder with dementia, for example, or a condition that makes communication difficult, may not be able to say if they want to receive an I.V. for dehydration.  An advance directive gives written instructions about what medical procedures may be used to extend a person’s life, when that person is not necessarily unconscious but for whatever reason cannot speak for him or herself. 

 An advance directive can also name someone, like a friend or family member, who is authorized to make medical decisions for the incapacitated patient.  This authorization can also be given in a Medical Power of Attorney, also known as a Healthcare Power of Attorney.  The Medical Power of Attorney names a personal representative to make decisions, but it does not have the full range of instructions that an advance directive would provide. 

 To further confuse matters, many people have heard of or prepared HIPAA release forms, which give doctors permission to share medical information about a patient with a designated person.  It would be a mistake to assume that a HIPAA form also functions as a Medical Power of Attorney.  All the HIPAA form does is let the doctor talk to family members (or other designated person), it does NOT give the designated person authority to make any decisions.  While this is certainly better than nothing, it may not be useful in difficult situations.

A personal example: A few years ago my 70-year-old father was in the early stages of a form of dementia that made it difficult for him to speak and swallow.  He became dehydrated, and developed pneumonia from breathing in liquids he tried to drink.  He went to the hospital, and we were shocked when the doctors asked about an advance directive.  He’d been riding a bike the previous week!  But dehydration and malnutrition had made him too weak and disoriented to be able to say if he wanted a feeding tube put in that could have extended his life.  His wife had a Medical Power of Attorney, but it only gave her the authority to decide, not instructions on what he wanted.  We ultimately decided as a family against a feeding tube, and he passed a few days later.  While I am sure we did the right thing, it would have been easier on us all not to have had to make that decision for him.

You can get HIPAA release forms from your doctors office, and there are widely available forms for a Medical Power of Attorney that may only need to be signed in front of an notary to enact.  An advance directive is a more complicated document, and should be prepared by an attorney.  Always use extreme caution with online forms!  Something as important as a legal documents related to your health is not where you want to be penny-wise and pound-foolish.