10 Common Mistakes People Make When Creating an Advance Health Directive

Creating an Advance Health Directive is one of the most important steps you can take to ensure your healthcare wishes are respected if you become unable to communicate them yourself. However, even with the best intentions, people often make mistakes that can limit the effectiveness of these crucial documents. Understanding these common pitfalls can help you create an Advance Health Directive that truly serves its purpose when needed most.

1. Being Too Vague About Medical Preferences

Perhaps the most common mistake is creating advance directives with overly general statements like "no heroic measures" or "nothing extraordinary." These vague terms mean different things to different healthcare providers, leading to potential misinterpretation of your wishes.

The Problem:

Vague directives force healthcare providers and your healthcare proxy to guess what treatments you would consider "heroic" or "extraordinary" in specific situations.

The Solution:

Be specific about medical interventions in different scenarios. For example, instead of saying "no heroic measures," specify whether you would want:

• Cardiopulmonary resuscitation (CPR)
• Mechanical ventilation and under what circumstances
• Feeding tubes for short-term vs. long-term use
• Dialysis
• Antibiotic treatments

Research from the National Academy of Medicine shows that directives with specific treatment preferences are more likely to be implemented correctly than those with general statements.

2. Failing to Update Your Directive Regularly

Advance care planning isn't a one-time task—it's an ongoing process that should evolve as your health, relationships, and values change over time. Many people create an advance directive and then file it away, never to be reviewed again.

The Problem:

Outdated healthcare directives may no longer reflect your current wishes or medical situation, potentially leading to care decisions that don't align with your current preferences.

The Solution:

Review your Advance Health Directive regularly, especially after:

• Major health diagnoses or changes in health status
• Significant life events (marriage, divorce, death of a spouse or healthcare proxy)
• Every 3-5 years, even without major changes
• When moving to a new state or country with different laws

According to the American Bar Association's Commission on Law and Aging, regular reviews ensure your advance directive continues to reflect your current values and wishes.

3. Choosing the Wrong Healthcare Proxy

Selecting someone to serve as your healthcare proxy (also called medical power of attorney) is a crucial decision that many people make without sufficient consideration.

The Problem:

People often choose their healthcare proxy based on family position (spouse, eldest child) rather than who would be most effective in the role. Some select individuals who:

• Are uncomfortable making difficult medical decisions
• May be too emotionally affected to think clearly in a crisis
• Don't understand or support the person's values and wishes
• Live too far away to be present when needed
• Lack the assertiveness to advocate with medical professionals

The Solution:

Choose your healthcare proxy based on who would best represent your wishes, considering:

• Their ability to understand medical information
• Willingness to advocate for your preferences, even if others disagree
• Emotional stability during stressful situations
• Geographical proximity
• Willingness to serve in this role

Medical ethics researchers emphasise that having detailed conversations with your chosen healthcare proxy is as important as the legal appointment itself.

4. Not Discussing Your Wishes With Family and Providers

Many people complete their Advance Health Directive privately without discussing their choices with family members or healthcare providers.

The Problem:

Without prior discussions, your healthcare proxy and family members may be surprised by your documented wishes, leading to:

• Confusion about your true intentions
• Challenges to the validity of your advance directive
• Conflict among family members during already stressful situations
• Difficulty interpreting your wishes in specific scenarios

The Solution:

Have explicit conversations about your healthcare wishes with:

• Your appointed healthcare proxy
• Close family members who might be involved in decisions
• Your primary care provider
• Specialists managing any chronic conditions

Studies show that these conversations significantly increase the likelihood that your end-of-life care will match your preferences.

Digital tools like those offered by Evaheld help facilitate these important family discussions by providing structured conversation guides and sharing capabilities.

5. Forgetting to Make Your Directive Accessible

Even a perfectly crafted Advance Health Directive is useless if no one can find it during a medical emergency.

The Problem:

Advance directives stored in safety deposit boxes, filing cabinets, or drawers at home are often inaccessible when needed most. Healthcare providers can't honor wishes they don't know about.

The Solution:

Ensure your advance directive is accessible by:

• Giving copies to your healthcare providers for your medical record
• Providing copies to your healthcare proxy and alternate proxy
• Sharing with close family members
• Using digital storage solutions that provide emergency access
• Carrying a wallet card indicating you have an advance directive and how to access it

Research published in JAMA found that advance directives stored in electronic health records were significantly more likely to be consulted during hospitalisations.

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Conclusion

Creating an effective Advance Health Directive requires thoughtful consideration, specific language, and ongoing communication with loved ones and healthcare providers. By avoiding these ten common mistakes, you significantly increase the likelihood that your healthcare wishes will be understood and honored, even when you cannot express them yourself.

Remember that advance care planning isn't just about completing paperwork—it's about engaging in meaningful conversations with loved ones, clarifying your values, and ensuring that your voice guides your care during vulnerable times. By approaching this process thoughtfully and avoiding common pitfalls, you provide an invaluable gift to yourself and your loved ones: the peace of mind that comes from knowing your care will reflect your deepest values and wishes.