Advance Directives

Definition

Advance directives are legal documents that allow adult patients to communicate their preferences for medical treatment in the event they become incapacitated. They protect patient autonomy and guide healthcare decisions when the client cannot speak for themselves.

Common Types

• Living will: Written instructions regarding life-sustaining treatments (ventilation, tube feedings, CPR).
• Durable power of attorney for healthcare (Healthcare Proxy): A designated surrogate decision-maker.
• POLST/MOLST: Physician/Medical Orders for Life-Sustaining Treatment. Portable medical orders for seriously ill patients.
• DNR/AND: Do-Not-Resuscitate or Allow Natural Death orders.

Patient Self-Determination Act

Federal law requires hospitals and Medicare/Medicaid-participating agencies to ask about and document advance directives on admission and provide information about state-specific rights.

Nursing Responsibilities

Verify and place directives in the medical record, advocate for honoring patient wishes, witness signatures when appropriate, and communicate the directive to all care team members. The nurse does NOT need to be a lawyer or notary but must ensure the document is accessible.

NCLEX Relevance

Central topic in the Ethics/Legal and Management of Care categories. Expect situational questions where advance directives conflict with family wishes, the patient’s documented wishes prevail.