What is an 'advance directive' and who should have one?

February 02, 2006

In Pennsylvania, adults generally have the right to decide if they want to accept, to reject or to discontinue medical care and treatment. What happens, though, when one needs medical attention but is physically or mentally unable to give instructions about medical care and treatment? The laws of Pennsylvania now provide people the right to give advance instructions concerning their health care should they become unable to make their own decisions about the medical care you wish to receive, and when at least two physicians have determined that an individual is in a terminal condition or a state of permanent unconsciousness. This is called an "advance directive," sometimes referred to as a "living will." Yet despite the literal life and death importance of such a document, many people don't have an advance directive.

An "advance directive" is a written document that describes the kind of "life sustaining treatment" one wants or does not want if he or she is unable to tell the doctor what kind of treatment they wish to receive. It is important to understand that Pennsylvania's advance directive law does not recognize all types of instructions, which might be contained in a person's "advance directive" or living will. Rather, those instructions must relate to situations where medical treatment would serve only to prolong the process of dying or to maintain a patient in a state of permanent unconsciousness. So, for example, Pennsylvania does not specifically recognize advance directives which will direct a health care provider to refuse medically beneficial care.

People should understand that an advance directive does not deal with financial and property matters. A separate document, generally a will, tells survivors what to do with a person's property after his or her death.

Any competent person who is at least 18 years old, is a high school graduate or has married, can make an advance directive.

An advance directive only takes effect when:

-- The doctor has a copy of it.
-- The doctor has concluded that the patient is "incompetent" and therefore no longer able to make decisions about the medical care he or she wishes to receive.
-- The patient's doctor and a second doctor have determined that the patient is in a "terminal condition" or in a "state of permanent unconsciousness."

"Incompetence" means "the lack of sufficient capacity for a person to make or communicate decisions concerning herself/himself." The law allows the doctor to decide if a patient is "incompetent" for purposes of implementing an advance directive and does not require a judge to make that decision.

There is no single correct way to write an advance directive. The directive is not valid, however, unless the individual has taken some important steps.

The patient must sign the advance directive. If an individual is unable to do so, someone else must sign it for the patient. Two individuals who are at least 18 years old must sign the directive as witnesses. Neither of those witnesses may be the person who signed the advance directive if the patient was unable to sign it.

The document should be dated, even though the law does not require it.

Give a copy of this document to the doctor, a responsible family member or guardian, hospital, nursing home or other health-care provider. Some may wish to provide a copy to clergy, a lawyer and others who could be involved in decisions about treatment. When a patient enters a hospital or nursing facility, the law requires the doctor or other health-care provider to ask the patient if he or she has an advance directive. If an individual gives a copy of an advance directive to his or her doctor or other health-care provider, that document must be made a part of the medical record.

Pennsylvania's advance directive law states that an individual may revoke the directive at any time in any manner. All that is required is for the patient to tell the doctor or other health-care provider that he is revoking it. Someone who saw or who heard him revoke his advance directive also may tell the doctor or other health-care provider about the revocation.

People can change or rewrite their advance directive at any time. If they change their mind after having written down their orginal instructions, however, they should destroy or revoke them and write new ones. People should consider telling everyone who participated in the decision-making process that they have changed their minds and give a copy of any new instructions to the doctor, health-care provider and anyone else who had a copy of the old instructions.

(Media Contacts)

Last Updated March 19, 2009