Advance directive
Formal Definition
A legal document outlining a patient's wishes for medical treatment if they lose decision-making capacity; includes living will (specific treatment preferences in defined situations) and healthcare proxy designation (naming a surrogate decision-maker); activated when the patient cannot communicate; distinct from physician orders like DNR/DNI which are immediately actionable orders.
How It's Used on the Ward
Advance directive or living will or healthcare proxy — the document that tells providers what an incapacitated patient would have wanted, or who should make decisions for them.
Example
"Patient found unresponsive, GCS 4. Retrieving advance directive: living will specifies "no tube feeding if permanently unconscious or terminally ill with <6 months to live." Healthcare proxy is the daughter. Daughter confirms: "Mom said she never wanted to be kept alive by machines." Feeding tube not consistent with her wishes. Documenting the discussion and the daughter's understanding."
Clinical Context
Types: Living will (treatment preferences, e.g., "no mechanical ventilation if..."), Healthcare proxy/Durable power of attorney for healthcare (surrogate decision-maker), combined documents. POLST (Physician Orders for Life-Sustaining Treatment): a medical order form, more specific than advance directive, follows the patient across care settings. Challenges to advance directives: patient not properly documented, family disagreement, outdated directives conflicting with current situation. Best practice: discuss advance care planning before illness, document in EMR, update when health status changes. In emergencies, act on available information — document the information source.