Advance Directives: Your Most Important Wish

When it comes to vacations, childbirth, weddings and college planning many of us receive high marks, yet planning for an unexpected health care crisis or end-of-life care is one event that slips off the radar.

National Healthcare Decisions Day, celebrated on April 16, is a time to plan for future health care decisions. With this intention, an advance directive is a legal document that provides instructions for end-of-life care and spells out whether life-sustaining treatment should be withdrawn or withheld when a person is dying or permanently unconscious.

“An advance directive speaks for the patient in their own voice when they’re unable to speak for themselves in certain situations,” says Susan Lyons, CRNP, palliative care nurse practitioner with Meritus Medical Center. Susan sees an advance directive as an “if then” document. “If I’m in a terminal condition and cannot speak for myself, then these are the medical treatments I do or do not desire,” says Susan.

Why bother?

In addition to providing instruction for future hospital treatment, advance directives allow for an appointment of a health care agent or power of attorney. In Maryland, the document must be witnessed by two individuals, but it does not require a notarized signature or the involvement of an attorney.

The advance directive becomes legally valid when you sign the document; however, it typically goes into effect when the doctor in charge of your care decides that you have lost the ability to make informed decisions about your health care. States also provide guidelines for when advance directives become active.

What matters the most

An advance directive also provides an opportunity to discuss what you value at the end of life. Do you want the support of a hospital-based medical team? Do you prefer to die at home with your beloved pet by your side?

Many people wish to die in their own home, but only a small percentage actually fulfill that hope. By planning ahead, an advance directive may eliminate unwanted hospitalizations. “To die at home usually requires a coordinated team approach including the support of a home hospice agency and round-the-clock supervision of family and/or friends,” says Susan. She suggests having a discussion with potential caregivers to specify who would be a part of a “home care support team.”

Start the conversation now

The best time to complete an advanced directive is when you’re healthy. “The emotional realities of a life-ending illness are too overwhelming,” says Susan. “Completing an advance directive allows for the discussion to be more neutral or removed from the illness or devastating medical condition.”

Susan suggests obtaining a blank advance directive form and using it as a conversation guide with your family or doctor. An appropriate time might be when a family member or friend has experienced a life-changing or life-ending event.

You can access an advance planning form by going to and After completing an advance directive, make sure to give a signed copy to your family and friends who will be involved in your care, your health care agent and primary care physician.

Decisions about end-of-life care are deeply personal and emotional, but starting a conversation and putting forth your wishes now will create peace at a time when it’s needed the most.