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Do you need an advance directive?

A person’s last will and testament outlines his or her wishes after death and addresses property, assets and general estate. But what about an advance directive? An advance directive, a foundational component of a living will, is a document that outlines your medical wishes while you’re still alive but unable to act on your own behalf.

“Having an advance directive is a gift to yourself and your loved ones. It makes it so your wishes will be honored,” said Colleen York, Bioethics Committee chairwoman at Southern Hills Hospital and Medical Center. An advance directive is important for most adults to have — not simply the elderly or terminally ill — because the documents will inform action taken in the event of an unforeseen emergency or accident.

Here are the basics for what you need to know when creating your advance directive.

An Advance Directive has two main parts

1. It names the person you’ve chosen to make medical decisions on your behalf if you’re unable to do so.

2. It explains your wishes for end-of-life medical care (including life-sustaining treatments, such as long-term respirator use, etc.).

An advance directive is made up of one or multiple documents, depending on the patient and his or her preference. The most common are the Nevada Declaration and the Durable Power of Attorney (DPOA) for Health Care. The Nevada Declaration handles your wishes for medical care and the DPOA is the form that appoints your agent.

These legal documents are used if you’re terminal (defined by Nevada law as having less than six months to live) and/or too incapacitated to make decisions or understand what’s happening with your medical care.

Basically, an advance directive is activated under rare, but critical, circumstances and power of attorney is called upon only when it’s absolutely necessary. Doctors are not required to follow aspects of an advance directive if they deem them to be medically inappropriate.

How do I create an advance directive?

You can find the documents needed to create your advance directive online or by request at many hospitals. Once the forms are completed, you’ll need to make them legal either by having them notarized or by signing them in the presence of two witnesses. However, there are guidelines about who a qualifying witness can be.

Once the forms are completed and legal, it’s best to make copies and give them to all relevant parties. This includes your chosen agent, close family members, your doctor/health care provider and your lawyer.

Nevada also uses an online filing system called Living Will Lockbox (livingwilllockbox.com) that you can use as a resource and upload your advance directive to. This helps ensure that your advance directive documents remain secure and are easily accessible.

When considering who to name as your agent, it can be helpful to ask yourself the following questions:

1. Is the person a close friend, family member or significant other?

2. Do you trust the person to make difficult decisions, and trust him or her to be considerate and flexible when doing so?

3. Is the person willing and comfortable to act on your behalf?

4. Does the person have prior knowledge of/context for your medical health?

5. Does the person fully respect and understand your wishes? Is the person willing to defend those wishes, within reason?

What if I'm someone else's agent?

These are some of the things you should know and be prepared for:

1. You’re agreeing to make important decisions, especially during emotional times. “As an agent, decisions are not a reflection of what you want, but what the patient wants,” York said.

2. End-of-life care is often complicated, and an advance directive cannot account for the exact, individual circumstances with which you may be faced. This means you’ll have to make decisions that may not have been expressly mapped out by the patient.

3. You’ll need to be knowledgeable and educated about the decisions you’re making, especially as they relate to procedures or treatment options. “Ask questions and listen for the burdens and benefits of each option,” York said. “If the burdens outweigh the benefits, this will help inform the decision-making process.”

4. Remember that there are things you won’t be able to decide or control for the patient. “You’re making as many decisions as are available, but keep in mind that the patient’s body may be failing and your job is, first and foremost, to honor the patient’s wishes,” York said.

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