Advance Directives

A medical crisis can happen to anyone, at any age, without warning. A car accident, a stroke, a surgical complication, a sudden illness — any of these can leave you unable to communicate your medical wishes. When that happens, someone needs to make decisions for you. And those decisions may involve the most profound questions in medicine: whether to continue treatment, whether to pursue aggressive intervention, or whether to focus on comfort and quality of life.

Advance directives are the legal documents that answer these questions — before the crisis occurs. They ensure that your doctors know your preferences, your family knows your wishes, and the person you trust most has the legal authority to speak for you.

Without advance directives, your family may face impossible choices without guidance. Family members may disagree about what you would have wanted. Doctors may default to the most aggressive treatment, even if that is not what you would choose. And the emotional burden on your loved ones — making life-and-death decisions without knowing your wishes — can be devastating.

Living Wills

A living will (sometimes called an advance directive for healthcare or a directive to physicians) is a written statement of your preferences for medical treatment in specific circumstances — most commonly, when you are terminally ill, permanently unconscious, or in a condition from which recovery is not expected.

What a living will can address:

• Life-sustaining treatment. Whether you want mechanical ventilation, CPR, feeding tubes, dialysis, or other interventions that prolong life when there is no reasonable hope of recovery
• Artificial nutrition and hydration. Whether you want tube feeding or intravenous fluids if you cannot eat or drink on your own
• Pain management. Your preferences for pain relief, even if it may hasten death (palliative sedation)
• Organ and tissue donation. Whether you wish to donate organs after death
• Specific treatments. Any particular medical interventions you want to receive or refuse

What a living will cannot address. A living will typically only applies in specific medical circumstances — terminal illness, permanent unconsciousness, or end-stage conditions. It does not cover every possible medical scenario. That is why a living will should always be paired with a healthcare power of attorney, which gives your agent the flexibility to make decisions in situations your living will does not directly address.

Clarity matters. Vague living wills can create as many problems as they solve. Phrases like “I do not want extraordinary measures” or “I want to die with dignity” mean different things to different people. I draft living wills with specific, unambiguous language that your doctors and your healthcare agent can follow with confidence.

Healthcare Power of Attorney

A healthcare power of attorney (also called a healthcare proxy) names a person — your healthcare agent — to make medical decisions on your behalf when you are unable to make them yourself.

This document is arguably the most important of all your advance directives. While a living will addresses specific scenarios, your healthcare agent has the flexibility to make decisions in situations you did not foresee. They can consult with your doctors, weigh treatment options, and make the call that best reflects your values and wishes.

Powers your agent may exercise:

• Consent to or refuse medical treatment on your behalf
• Choose or discharge physicians and healthcare facilities
• Access your medical records under HIPAA
• Make decisions about surgery, medication, therapy, and rehabilitation
• Decide about end-of-life care in situations not covered by your living will
• Authorize organ or tissue donation
• Make decisions about post-death arrangements

Choosing the right person. Your healthcare agent should be someone who understands your values, can remain calm under pressure, is willing to advocate forcefully for your wishes (even under pushback from medical staff or family), and is available when needed.

This is a different choice than your financial power of attorney. The person best suited to manage your bank accounts may not be the right person to make life-and-death medical decisions. I help clients think carefully about who is the right person for each role.

HIPAA Authorizations

The Health Insurance Portability and Accountability Act (HIPAA) restricts who can access your medical information. Without a HIPAA authorization, your healthcare providers may refuse to share your medical records, test results, or treatment information with your family members — even your spouse.

A HIPAA authorization is a simple but essential document that designates the people who are permitted to access your protected health information. It works in conjunction with your healthcare power of attorney, ensuring that your agent and other designated family members can:

• Speak with your doctors about your condition and treatment options
• Access your medical records and test results
• Receive updates on your health status
• Participate in care planning discussions

Without a HIPAA authorization, your healthcare agent may face bureaucratic barriers at precisely the moment they need information most. I include HIPAA authorizations as a standard part of every advance directive package.

DNR Orders and Life-Sustaining Treatment

A Do Not Resuscitate (DNR) order is a specific medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if your heart stops or you stop breathing. It is different from a living will — a DNR is a physician’s order, while a living will is your directive.

When a DNR may be appropriate. DNR orders are most commonly used by people with terminal illnesses, advanced age, or conditions where CPR would be unlikely to succeed or would result in a quality of life the person would not want. However, any adult can request a DNR order after discussing it with their physician.

Oklahoma”s Noncardiopulmonary Resuscitation (Do-Not-Resuscitate) Act. Oklahoma has specific legislation governing DNR orders, including requirements for how they must be documented and communicated to emergency medical services. I ensure that if a DNR is part of your plan, it is properly documented and accessible to first responders and hospital staff.

Other life-sustaining treatment decisions. Beyond CPR, your advance directives can address other interventions:

• Mechanical ventilation (breathing machines)
• Artificial nutrition and hydration (feeding tubes, IV fluids)
• Dialysis
• Blood transfusions
• Antibiotics for life-threatening infections
• Comfort care and palliative measures

Each of these decisions deserves thoughtful consideration. I help clients understand what each intervention involves, what it means in different medical scenarios, and how to document their preferences clearly.

Having the Conversation

Creating advance directives is not just a legal exercise — it is a family exercise. The documents are most effective when the people who matter most understand your wishes.

Talk to your healthcare agent. Make sure the person you choose understands your values, your priorities, and the specific decisions you have documented. Do not just hand them the paperwork — have a real conversation about what matters to you.

Talk to your family. Even family members who are not named as your healthcare agent should understand your general wishes. This reduces the chance of conflict during a crisis and helps everyone support your agent’s decisions.

Talk to your doctor. Your physician should have a copy of your advance directives and should understand your preferences. If you have strong feelings about specific treatments or interventions, discuss them with your doctor so your medical record reflects your wishes.

These conversations can be uncomfortable. Most people do not want to think about their own incapacity or death. But the alternative — leaving your family to guess what you would want during the most stressful moments of their lives — is far worse.

I help clients approach these conversations thoughtfully and provide guidance on how to discuss difficult topics with family members who may be reluctant to engage.

Coordinating Advance Directives With Your Estate Plan

Advance directives are one component of a comprehensive estate plan. They should be coordinated with your other documents to ensure consistency and avoid conflicts.

Your financial power of attorney addresses your financial affairs during incapacity. Your advance directives address your medical care. Together, they ensure that both your finances and your healthcare are managed by people you trust, according to your wishes.

If you have a trust, the trustee may need to coordinate with your healthcare agent on financial decisions related to your care — such as paying for medical expenses, modifying your living situation, or accessing funds for home health services.

And if Medicaid planning is part of your strategy, your advance directives play a role in long-term care decisions that directly affect your financial plan.

I design all of these documents to work together as a unified plan. Every provision in every document should complement — not contradict — the others.