An advance directive is a general term for any document in which you provide instructions about your healthcare wishes or appoint someone to make healthcare decisions for you should you become unable to make decisions for yourself in the future. They are signed in "advance" and shared with your healthcare representative, loved ones, and key healthcare providers to inform them of your wishes concerning medical treatment should you become unable to speak for yourself. These documents and preferences may be changed or cancelled at any time either verbally or in writing.

In Indiana, a healthcare representative is the person chosen by a loved one, family member, or friend to make healthcare decisions, including end-of-life decisions, in the event a person becomes unable to make his or her own decisions. In other states, they may be called an agent, a surrogate, a healthcare power of attorney, or another name.

It is important that you name a person who knows your goals and values and whom you trust to carry out your wishes as your representative. Many people name a family member, but it is not necessary to do so. It is important to think carefully about this decision. A healthcare representative should be willing to do the following: accept this role; talk with you about your goals, values, and preferences; follow your decisions, even if he or she may not agree with them; serve as your spokesperson and advocate; and make decisions in difficult moments.

No. Appointing a healthcare representative does not take away any of your authority. You always have the right and the authority, while you are still competent, to override the decisions of your representative or to revoke the directive. In Indiana and in most states, a doctor determines if a person is unable to make his or her own decisions.

If you do not appoint a healthcare representative, Indiana law determines who will make decisions for you. These persons are called “Proxy Decision Makers,” and they are identified in hierarchical order in the Indiana Code: IC 16-36-1-5. If you become unable to make decisions for yourself and do not have an advance directive that can be located, the physician taking care of you will try to contact a member of your immediate family in the priority order designated by Indiana law. Your healthcare decisions will be made by the first person on the list the physician is able to contact.

A living will is also called a “Statement of Healthcare Preferences,” and is a type of advance directive in which you state your wishes about the medical care and treatment you want or don’t want if you are no longer able to speak for yourself. Normally, living wills address one’s preferences about end-of-life medical treatments, but they can also communicate your wishes, values, or goals about any other aspect of your care and treatment.

Advance care planning is important for all adults at all stages of life and health and is a part of routine, high quality healthcare. All adults should choose a healthcare representative and create a living will - identifying their preferences for medical care if they suffered a serious injury or health condition that resulted in their not being able to make decisions for themselves. The best time to create an advance directive is NOW - before you are sick or injured - when you have a clear understanding about your options and can communicate them to your loved ones and your doctor.

There are many things in life that are beyond our control. Advance directives give you a way to control something that is very important – how you are treated if you should become seriously ill. After an accident or during a serious illness you may become unconscious, delusional, or unable to communicate your wishes regarding medical treatment. Advance directives help you to communicate with family, friends, and doctors about how you want to be treated if you become seriously ill. Advance directives protect your family members because they won’t have to guess what you want and make hard decisions without knowing your wishes. Advance directives help you know what your loved ones want so you can be there for them when they need you most. Studies show that families who engage in the advance care planning process have less stress, confusion, and complicated guilt about their decisions and the loss of their loved ones.

Advance directives are not required. Your physician or hospital cannot require you to make an advance directive if you do not want one. No one may discriminate against you if you do not sign one. Physicians and hospitals often encourage patients to complete advance directive documents because research has found that patients, their loved ones, and their healthcare providers benefit from having had these important conversations.

No. Treatment that is no longer helping can be stopped without an advance directive. Physicians will seek to consult with your healthcare representative or close family if you should become unable to speak for yourself. The goal is to make decisions that are in your best interest – decisions that you would make if you had the capacity to speak for yourself. However, having an advance directive can make the right decisions easier and help avoid family disputes.

No. Most of us have some uncertainty or ambivalence about what we would want. A young adult may not be ready to contemplate end-of-life but can think about and appoint a healthcare representative in case of a serious accident or illness. As one matures and faces new health conditions and family experiences, values, goals, and priorities change, and a person may change their advance directives. When one enters a stage of advanced illness, goals of care change again, and as end-of-life approaches, greater specificity about what one wants or doesn’t want becomes a greater focus of advance care planning. A person who is competent may change their advance directives at any time, either verbally or in writing.

No. Indiana, like most states, do not require a particular form, but they do have witnessing requirements or other special signing formalities that should be followed.

Yes. In Indiana advance directives must be signed by two witnesses OR signed by a notary. However, witnessing and notarizing requirements vary from state to state. States typically require witnessing by two adults and they may limit who may witness. Some states disqualify persons as witnesses who are related to you, who will inherit from you, or for whom you are financially responsible. Because of state-to-state differences, it is a good idea to have your advance directive both witnessed AND notarized if you travel frequently or reside in multiple states.

In Putnam County, Indiana, the Putnam County Hospice and Palliative Care Association provides free information and resources about advance care planning. For individualized assistance, you can contact the Association at either 765.301.7614 or email at This email address is being protected from spambots. You need JavaScript enabled to view it.. Many resources are provided at www.pchpca.org. Most physicians, hospitals, and senior living facilities can provide you with forms and assistance or refer you to a source. Most attorneys will provide assistance for a fee but may offer pro bono services.

No. However, you may want to discuss your advance directives with an attorney. For example, an attorney may be helpful in advising you on complex family or financial matters, protecting you if you live in multiple states, or ensuring that advance directives prepared in another state are recognized in Indiana.

As long as you are competent and able to make and communicate your own decisions, it is your right to make your own medical decisions. Therefore, your advance directive goes into effect only when you are no longer able to make or communicate your decisions. If, however, you are concerned about your ability to make reliable decisions, you may give your healthcare representative the authority to act on your behalf on the day you sign the document.

You may change or revoke your advance directive at any time. As a rule, your advance directive is effective until the time of your death. However, it is recommended that you review your advance directive periodically, especially when there is a change in your health or living status. Date and initial it following every review, make copies, and discuss any changes with your healthcare representative, loved ones, and physicians.

Make copies of your advance directive. Put the original in safe place. Keep a copy in an accessible, known location. Provide copies to your healthcare representative and other appropriate individuals (i.e., physicians, loved ones, clergy, attorney, etc.). Discuss the details of your advance directive with these individuals. Ask your physician to make it part of your permanent medical record. Whenever you are hospitalized or go on a trip, take a copy with you. Put a card in your wallet that states that you have an advance directive, identifies the person you have named as your healthcare representative, and provides his/her contact information.

Yes. If healthcare providers are aware of and have access to your advance directive, you should expect that your directions will be carried out. Healthcare providers have both legal and ethical duties to respect patient directions, whether verbal or written. However, doctors may always refuse to comply with your wishes if they have an objection of conscience or consider your wishes medically inappropriate or illegal. The only reliable strategy is to discuss your values and wishes with your healthcare providers ahead of time, to make sure they are clear about what you want, are willing to support your wishes, and document your wishes. In addition, your directions are more likely to be known and honored if you have named a healthcare representative to advocate for you and act on your behalf.

It depends. If you are living with a life-limiting condition, the best way to ensure that your instructions and values are honored is to speak with your doctor to determine if specific physician orders (OOHDNR or POST) should be written for first responders and hospital providers. The person you have appointed as your healthcare representative and your loved ones should be made aware of and given a copy of your physician orders.

Usually, yes. An advance directive is usually NOT helpful in this situation. EMS must attempt to resuscitate you and transport you to a hospital, UNLESS they are presented with a fully executed medical order such as an Out-of-Hospital Do-Not-Resuscitate (OOHDNR) Order or a Physician Orders for Scope of Treatment (POST) Order. Furthermore, if you have such orders in place, it is vital that you keep them accessible in your home and on your person, because a copy of the physician order must be presented to EMS at the time of the emergency.

An OOHDNR is a medical order, designed for patients with advanced, progressive illness or frailty. It must be signed by a physician, nurse practitioner, or physician assistant. An out of hospital do not resuscitate order does NOT mean “do not treat.” The order addresses medical treatment in the case of cardiac arrest only. In the absence of other legal guidance, the patient with an OOHDNR should receive medical treatment for all other conditions and situations according to the standard of care. The order covers cardiac arrest that occurs outside of a hospital only; the order does not legally extend to patient care within a hospital. A person should always be kept as comfortable as possible and receive palliative care if needed.

In Indiana, the POST form is a set of medical orders designed for patients with advanced, progressive illness or frailty. The POST form expresses these orders in a standardized format that addresses key critical medical care decisions consistent with the patient’s goals of care. The completed POST form should be printed/copied on pink paper. It is designed to facilitate shared, informed medical decision-making and communication between healthcare professionals and patients with advanced, progressive illness or frailty. The medical orders in a POST form are portable and govern care across healthcare institutions. In other states, this form may be called other terms, such as Medical Orders for Life-Sustaining Treatment (MOLST) or Physician Orders for Life Sustaining Treatment (POLST).

You and your healthcare representative will not be able to anticipate every clinical situation that may arise, and it may not always be clear exactly what you would want. Your healthcare representative will need to work with your healthcare providers, other caregivers and loved ones to make sure everyone stays focused on how your instructions should be honored and how to protect your best interests. The more information your representative and providers have, the better equipped they are to make good decisions. You can assist your representative in preventing your wishes from being overridden by making sure family members know your wishes and how much confidence and trust you place in your representative and your providers to make decisions on your behalf.