Advance Directive
A legal document expressing a person's wishes regarding medical treatment if they become incapacitated, encompassing a living will and/or a healthcare power of attorney.
An advance directive is the general term for legal documents that guide medical decision-making if an individual loses the capacity to communicate or decide for themselves. The two primary components are: (1) a living will (or directive to physicians), which specifies the individual's preferences about specific treatments — mechanical ventilation, artificial nutrition, CPR, dialysis — under defined circumstances such as terminal illness or permanent unconsciousness; and (2) a healthcare power of attorney (or healthcare proxy), which designates a specific agent to make medical decisions on the individual's behalf.
Advance directives are governed by state law and vary in format, witnessing requirements, and scope. An out-of-state document may not be recognized unless it substantially complies with the destination state's requirements. Completing both documents together provides comprehensive coverage: the living will handles situations the documents specifically address, and the healthcare proxy handles situations not explicitly covered.
For Medicare-covered patients, the Patient Self-Determination Act (1991) requires hospitals, SNFs, hospices, and home health agencies to inform patients of their right to complete advance directives and document whether one exists in the medical record. Medicare Part B covers advance care planning discussions with a physician as a separately billable service (CPT 99497/99498).
Real-World Example
After completing a living will specifying no mechanical ventilation if in a persistent vegetative state and designating his daughter as healthcare proxy, a 74-year-old had both documents notarized, gave copies to his primary care physician, cardiologist, and the local hospital — ensuring his wishes were honored when a stroke left him incapacitated.