WHAT IS AN ADVANCE DIRECTIVE?
Advance medical directives are legal documents that allow you to direct your medical care in the event of a medical emergency during which you are unable to speak for yourself. Types of advance directives include a living will and durable power of attorney for health care.

HOW DO I GET STARTED?
Making decisions about your health care in the event of a life-threatening, irreversible or incurable illness can be very difficult. As a first step, define what your quality of life is now. Secondly, consider what you fear the most if you are injured or seriously ill. Also, make a list of limitations that would create an unacceptable quality of life for you.

WHAT TYPES OF MEDICAL TREATMENT SHOULD I CONSIDER?
There are basically three categories of medical treatment at the end of life:

• Life-Supporting Measures include cardiopulmonary resuscitation and machines that keep your heart and lungs going when they no longer can work on their own. This also can include use of a ventilator or respirator to provide oxygen to you through a tube.
• Life-Sustaining Measures include treatment and machines that prolong life when a condition cannot be reversed or cured. Examples of these treatments and machines include tube feedings, intravenous fluids and kidney dialysis.
• Life-Enhancing Measures include treatments that keep you comfortable while allowing death to occur naturally. Nothing is done artificially to prolong life. Hospice services and use of appropriate pain medications are examples of measures that provide comfort care only.

WHAT KINDS OF ADVANCE DIRECTIVES ARE AVAILABLE?
The two types of advance directives most commonly available are:

• Living Will: A document that specifies the type of medical treatment or procedures you would like to receive if you become terminally ill. A living will takes effect only when you become terminally ill (when it is clear you will not recover). A living will may direct an attending physician to withhold or withdraw medical treatments that merely prolong the dying process. A living will may not direct anyone to withhold or withdraw artificial nutrition and hydration. In Missouri, you and two witnesses must sign a living will.
• Durable Power of Attorney for Health Care (DPOAH): This document identifies a spokesperson (agent) to act on your behalf, and must be signed by you, in front of a notary public. It takes effect when you are unable to make health care decisions for yourself. Unlike a living will, a DPOAH may authorize your agent to withhold and/or withdraw artificial nutrition and hydration if this has been specified in the document. The designated spokesperson must be comfortable with your decisions. A Durable Power of Attorney will not go into effect unless you are unable to communicate yourself.

WHO NEEDS ADVANCE DIRECTIVES?
Everyone needs advance medical directives. If you currently have such advance directives in place, it is important to send copies of this information to your doctor and your loved ones. If you do not, it is time to talk with your physician and your family members about advance directives. Without advance directives, your family, your loved ones and your physician will be unable to support your wishes.