Advance Directives: What they are & how they work

Stated simply, an advance directive is just another powerful tool in your estate planning arsenal. Together with a Will (and for some a Trust), an advance directive will ensure that your wishes will be honored if you are unable to make medical decisions for yourself. There are enough medical dramas and tragic romance novels out there to know that when the time comes, we may not necessarily find ourselves warm and snug in our beds at the ripe ol’ age of 101. Out of all of them, that only happened like one time. In the Titanic. (RIP, Rose.)  

In fact, as TMC News reports, 1 in 4 elderly Americans don’t die at home, cozy in bed with their family holding vigil…they die in the ICU. Hooked up to machines, surrounded by strange nurses and orderlies. Without an advance directive to outline their wishes regarding extreme measures, doctors and nurses are obligated to try anything and everything to save their life. TMC also reports that the U.S. spends about $205 billion dollars annually on medical treatment given to a person in their final year of life. Twenty-five-percent of that $205 billion comes from Medicare’s pocket. And these attempts at saving a life, however brave and innovative some of them may be, are often in vain and can cause even more heartache and pain for both the patient and their families…  

So, what can be done? What can you do? The answer lies in an advance directive. *cue dramatic music*  

What is an Advance Directive?  

There are two types of legal documents that allow you the opportunity to communicate your end-of-life wishes regarding your healthcare: a living will and a Healthcare Power of Attorney. A living will outlines the types of health care decisions that can be made on your behalf in the event that you are rendered incapacitated. It also provides a means for others to receive information about your healthcare.  This is especially important for those who don’t have family around or who wish to restrict their information and/or decision making to a particular person who is not a family member.    

A Healthcare Power of Attorney (POA) gives decision-making power to a person of your choosing (your Health Care Agent). Your agent can make decisions for you if you don’t have a living will or act on your behalf to ensure that doctors and medical staff adhere to your wishes as set forth by your living will. 

This isn’t something that should be taken lightly. When sitting down to create your advance directive, you’ll need to consider and address a myriad of important medical decisions. For instance, you’ll need to decide if you want to opt for surgeries that carry significant risk, if you want to be kept alive using machines, whether you should be provided artificial nutrition and hydration, what should be done with your body if and when you do pass away…and so much more. The point of an advance directive is to make clear what your wishes are so that medical and hospital staff and your family can honor them, rather than creating a situation where others will need to decide for you.   

How do I get one?   

Many healthcare organizations such as doctors’ offices and hospitals have a standard advance directive form that you can fill out. These pre-made forms can make it easier for hospital staff to follow your wishes. You can also get one from the Maryland Attorney General’s website. However, there is no ‘official’ template for creating an advance directive in Maryland. As long as your advance directive meets the standards outlined in the Maryland Health Care Decisions Act, then it will be effective.   

Advance directives in Maryland have three main components:   

1. Selection of a Health Care Agent. Your Health Care Agent will be the person making health-care-related decisions for you while you are unable to do so for yourself. You can give this person as little or as much power as you want. It may also be prudent to list a back-up Health Care Agent in case your first choice is unavailable.   
2. Treatment Preferences  
3. Signatures of you and your witnesses  

Is an advance directive right for me?   

We can’t plan how our death is going to go down. We may want to go quietly, or in a blaze of glory. But we don’t actually get a say in any of that. What we do get a say in is what happens when it’s all going down, regardless of the how’s and the why’s. An advance directive is for you if you want to have a say in the things that can be controlled. An advance directive is for you if you don’t want your family or loved ones to have to make crucial time-sensitive decisions regarding your medical care at a time when emotions can be so raw and overwhelming. An advance directive is for you if you don’t want those same family members to be stuck with huge hospital bills for unnecessary procedures performed before you passed.   

An advance directive is for you if you want a well-rounded estate plan that includes the ability to ensure your end-of-life wishes are considered when others are making such decisions on your behalf. If this sounds like you, give Ferrante, Dill & Hisle partner and Estate Planning attorney Jennifer Dill a call today at (410) 535-6100 or send her an email at info@ferrantedill.com.