Advance Care Planning and Advance Directives FAQ
What is advance care planning?
This is the process of talking about and writing down your wishes for medical care if you become unable to speak for yourself.
What is an advance directive?
An advance directive is written instructions about health care treatment made by adult patients before they lose decision-making capacity. An advance directive may include a:
- Health Care Proxy Form;
- Nonhospital Order Not to Resuscitate (DNR); and/or
- Medical Orders for Life Sustaining Treatment (MOLST).
Who is advance care planning for?
Advance care planning is for anyone over age 18. It is important that your family and loved ones know your wishes if you become unable to make health care decisions for yourself.
What is a health care agent?
A health care agent is someone you trust and choose to make health care decisions for you if you become unable to make your own decisions.
What is a health care proxy?
A heath care proxy is a document you use to appoint your health care agent.
Who should have a health care proxy?
Everyone older than 18 should have a health care proxy. It should be updated every few years and during major life events, such as:
- Going to college;
- Entering a long-term relationship;
- Getting married;
- Getting divorced;
- Having or adopting a child;
- Receiving a medical diagnosis;
- Planning a major trip; or
- After a change in health care or medical status (positive or negative).
Who can be a witness for the health care proxy?
Anyone over the age of 18, except for the person appointed as the health care agent, can be a witness.
What if I don’t appoint a health care agent?
If you don’t appoint a health care agent and you lose capacity to make decisions for yourself, a surrogate will be chosen from the surrogate list set forth in the Family Health Care Decisions Act. A surrogate, in order of highest priority may be a:
- Spouse, if not legally separated from the patient, or domestic partner;
- Son or daughter 18 or older;
- Parent;
- Brother or sister 18 or older; or
- Close friend.
What is a Living Will?
A living will is a written statement of your specific health care wishes in the event you become unable to decide for yourself.
New York State does not have a standard living will form. New York State does recognize living wills as valid if they provide "clear and convincing evidence" of the person's wishes.
What is a Nonhospital Order Not to Resuscitate (DNR)?
A nonhospital DNR order means that emergency medical services (EMS) staff will not begin CPR, which includes actions such as:
- Mouth-to-mouth resuscitation;
- Chest compressions;
- Electric shock;
- Inserting a tube to open your airway (intubate); and/or
- Injecting medication to restart your heart.
Who should have a Nonhospital Order Not to Resuscitate (DNR)?
A nonhospital DNR order is commonly used for someone with a serious health condition, advanced age, or terminal illness and must be signed by a health care provider. If someone has a nonhospital DNR order, and they stop breathing or their heart stops beating, CPR and other potentially-invasive, life-sustaining treatments will not be started.
Examples of serious health conditions include:
- Advanced stage cancer diagnosis;
- Congestive heart failure;
- Chronic obstructive pulmonary disease (COPD);
- Dementia diagnosis; or
- Frailty when a person nears the end of their natural life.
What does resuscitation and intubation mean during Cardiopulmonary Resuscitation (CPR)?
CPR is used when your breathing or heart stops. It involves someone pushing air into your mouth and pushing down very hard on your chest with their hands. It can also involve being given medication to make your heart start again -- or restarting your heart using a machine called an automatic external defibrillator (AED). This provides an electric shock to keep your heart beat normal. Intubation is when a plastic, flexible tube is inserted through your mouth -- and then into your lungs. This helps you breathe if you stop breathing.
If I'm not at home when I have a medical emergency, how will medical personnel know that I have a DNR order?
You can carry your DNR order with you. You can also wear a DNR bracelet or necklace to indicate that you have a DNR order.
What is a Medical Order for Life-Sustaining Treatment (MOLST) Form?
This is a medical order filled out by you and your health care provider. A MOLST is not for everyone. Typically, a MOLST is used by someone who:
- Wants to avoid or receive any or all life-sustaining treatment;
- Resides in a long-term care facility or requires long-term care services; or
- Might die within the next year.
Where should I keep the forms after I fill them out?
Your current forms should be kept in your home. A copy should be given to your health care agent and to all your health care providers.
If you have a DNR or MOLST, store it where emergency responders can easily find it.
If you are traveling, you should keep a copy of your forms with you. If you are visiting family or close friends, a copy should be kept with them for the duration of your trip.
For more detailed information
Visit Deciding About Health Care: A Guide for Patients and Families.
