Why Advance Medical Directives Matter for Your Estate Plan

Advance Medical Directives

A Difficult Scenario to Imagine

Okay, so you’re in a hospital, unconscious, and unfortunately your condition is such that, in the professional opinion of the doctors who are treating you, you are not going to regain consciousness, nor are you going to recover. In short, you are in the process of dying, and it won’t be long before the end comes. The doctors can prolong your life by providing you with food and hydration via IVs and a nasogastric tube. They also can perform surgeries and other extraordinary (and expensive) procedures to give you more time. But all these efforts are not going to restore you to any reasonable level of health and may cause you significant suffering.

The Burden on Loved Ones

Since you are unable to communicate with the doctors, they turn to your loved ones for direction. Should they take every possible measure to extend your life? Should they try methods and procedures that are still in the testing phase? And when those efforts have run their course and you do pass away, do you want any of your body parts to be donated? Your loved ones have a general sense of your wishes, but you’ve never had a detailed conversation about any of this with them. Now, they are placed in the position of trying to guess what you would want, balancing the potential of forestalling the end of your life against the possibility of extended pain and suffering.

Estate Planning as a Solution

None of this is pleasant to think about. But estate planning gives you a chance to work through these unpleasant scenarios productively and come out the other end with a solid plan. That plan will provide guidance to those who may have to make medical decisions on your behalf in the future.

An advance medical directive is a legally recognized document that will allow you to plainly state your preferences regarding your end-of-life and can cover details such as organ donation and who has authority to make medical decisions on your behalf. An advance medical directive is signed and notarized and gives those consulting it confidence that they can rely on its instructions without undue risk of liability.

Why Advance Directives Are Essential

According to polling by the University of Michigan, about 46 percent of older adults had completed at least one legal document dealing with advance medical care planning. That means over half of older adults in America have not taken this step.

The American Medical Association’s Code of Medical Ethics provides guidance to physicians when a patient lacks decision-making capacity. This guidance directs physicians to identify an appropriate surrogate to make decisions on the patient’s behalf. This surrogate, the guidance states, typically will be “a family member or other intimate associate.” The physician and the surrogate determine the best course of action for the patient’s treatment based on statements the patient made about his or her life, sickness, suffering, and specific medical procedures, before becoming incapacitated. If the physician believes the surrogate’s decision is in obvious conflict with what the patient would have wanted, the guidance directs the physician to consult an ethics committee or other institutional resource. Looking at this guidance, it’s easy to see how making your wishes clear via an advance medical directive can avoid confusion and conflict should you become unable to speak for yourself.

Indeed, the American Medical Association’s position is that “advance care planning is valuable for everyone, regardless of age or current health status.” The Association encourages physicians to routinely engage their patients in advance care planning and involve the patient’s potential surrogate in these conversations whenever possible.

Making Your Directive Accessible

Understanding and acting on the need for an advance medical directive is a key step toward ensuring that your wishes will be carried out even if you are unable to express them yourself. Another useful step that often is overlooked is making sure that your advance medical directive is available to those who will need to have access to it in the event you are incapacitated. There are couple ways to do this. One option is to share a copy of your advance medical directive, along with related documents such as a health care power of attorney, with your primary care provider. Another option with a wider reach is to submit these documents to your state’s advance health care directive registry. In Virginia, this registry is maintained by the commonwealth’s department of health. The registry was established by statute (Virginia Code § 54.1-2995) and allows a person to file the following documents:

  1. A health care power of attorney.
  2. An advance directive created pursuant to Article 8 (§ 54.1-2981 et seq.) or a subsequent act of the General Assembly.
  3. A declaration of an anatomical gift made pursuant to the Revised Uniform Anatomical Gift Act (§ 32.1-291.1 et seq.).
  4. Any other document that supports advance health care planning, including Durable Do Not Resuscitate Order or portable medical order forms.

These documents are exempt from disclosure under the Virginia Freedom of Information Act. Once you submit your documents to the registry, you receive a wallet ID card that provides information that allows you and anyone else you wish to access the documents you have submitted. So, in the future, all you have to do is share your ID card with physicians and other loved ones to provide them with access to your documents. There is no charge to use the registry, and you can withdraw documents from the registry at any time. You can find more information about the registry here:

Take the First Step

Having the foresight and courage to think through difficult end-of-life scenarios can help you develop a plan that creates meaningful peace of mind for you and your family. Speaking with a qualified estate planning attorney is a great way to get started on developing that plan. Schedule a consultation with the Law Office of Levi Jones for more information on how an advance medical directive fits into your estate plan.