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MYTH: Healthcare providers must follow advance directives because they're legally binding.
FACT: Although the patient always is the ultimate decision maker, healthcare providers can refuse to follow an advance directive if they have a conscientious objection or consider the patient's wishes medically inappropriate. In that case, they may be obligated to transfer the patient's care to another healthcare provider who will honor the patient's wishes. The best strategy is for patients to discuss their wishes with their healthcare providers ahead of time. This way, healthcare providers understand which treatments their patients want and don't want, and patients know whether their healthcare provider will support their wishes.
MYTH: Patients should wait to sign advance directives until they're sure about what care they want.
FACT: Like a will, an advance directive can be changed whenever a patient wishes. Patients also can verbally express a desire to change an advance directive, and put the update into writing later. Document what the patient says and when it was said, and communicate the changes to the appropriate healthcare providers. Because end-of-life treatment can be unpredictable, most patients are ambivalent about what they want. However, patients can at least appoint a healthcare proxy (also called a durable power of attorney for healthcare), who can make treatment decisions for a patient who's unable to do so.
MYTH: Naming a healthcare proxy means patients give up their rights to make treatment decisions.
FACT: Competent patients retain their right to make treatment decisions, and can override the decisions of a healthcare proxy or revoke their advance directive. The proxy takes over only if the patient becomes incapacitated or incompetent and can't make decisions.
MYTH: Young adults have little need for advance directives.
FACT: Every adult should have an advance directive. Young adults have more at stake if they're in a serious accident or become seriously ill, because some incapacitated patients can be kept alive for decades on life support.
Sources: Myths and Facts about Health Care Advance Directives, American Bar Association. http://www.abanet.org/aging; Advance Directives. http://www.emedicinehealth.com.
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