A Time and Place for Being “Controlling”

There is at least one instance where being “controlling” is a good thing – it’s when you or your loved one leave an Advance Directive. You are giving orders through a piece of paper when you can’t otherwise make your wishes known.

What is an Advance Directive?

It is a legal form that specifies the circumstances under which you or your elder want intervention to prevent death and when you don’t. The Advance Directive tells medical providers and healthcare professionals what kind of end of life care you want, what procedures you want to be used and which you don’t. It also gives directions about organ donation. Advance Directives are usually paired with a medical power of attorney.

Why is it important to be in control here?

If you or your elder are incapacitated and cannot give directions about care, if the situation is life-threatening and time is limited, the Advance Directive speaks for you or your elder in a clear, concise and definitive manner.

Without an Advance Directive, the care providers (who may not know you or your elder) may be the ones making the decisions about what procedures or care measures you might want or need. Your loved ones may be making decisions for you or your elder with a medical power of attorney. But, they may not be aware of what your preferences are and the priorities you would give if you were able to voice your opinion.

An Advance Directive allows you or your elder to have a voice about the care of your body, even when unconscious, in a coma, severely injured, have dementia or are in a life-threatening medical situation. It details when or if you would want care withheld or withdrawn.

Sometimes this directive is called a Do Not Resuscitate Order or DNR. Most often, an advance directive is called a Living Will. Each state has different forms, procedures and, often, different names for this. You’ll want to consult an attorney for specifics.

What kinds of treatment does an Advance Directive specify?  For example:

  • In what instances would a feeding tube be allowed and when it wouldn’t
  • Under what circumstances would a ventilator or breathing device be used and when it wouldn’t
  • When should CPR be used and when it should be withheld
  • What types of lifesaving measures are acceptable and when should they be used, as well as when they should be discontinued
  • If in a permanent vegetative state, how long and in what medical condition would you want your life prolonged?
  • Your preferences about organ donation

Advance Directives are most often written under the guidance of an attorney and, usually, need to be witnessed, notarized and may require a physician’s signature as well.  Again, the requirements will vary by state.

In addition to having a written Advance Directive, please have a discussion with the people who will hold medical power of attorney and/or close family members. The medical team will be asking for direction and guidance from these folks in life-threatening situations. They should know the wishes of you or your elder, even without the form. Talk about it. Open up about when you would want lifesaving measures and when you wouldn’t. Tell them if you want to be an organ donor.

Advance Directives allow the wishes of the one receiving care to, hopefully, be the controlling voice in life-threatening scenarios.


*A big disclaimer here – I’m not offering legal advice. I’m not an attorney. Legal forms, their terminology and their requirements vary by state. Consult with an attorney about advance directives. This is just a discussion to get started.



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