Patient Advocate Designation

An advance medical directive (AMD) may contain several sections to complete, and this can be overwhelming for some. The Patient Advocate Designation (or “Durable Power of Attorney for Healthcare”) is the most important section and is the only component required for a legally valid AMD. 

The Patient Advocate Designation is your opportunity to document who you would want to make medical decisions for you if you were unable to make the decisions yourself. We encourage everyone age 18 or older, regardless of current health status, to designate who they trust most to speak for them during times when they cannot speak for themselves. 

If you were to ever become so sick that you could not speak or make your own decisions, who would you most want and trust to help make medical decisions on your behalf?

Your answer to the above question represents who you would document as your patient advocate. You can list additional individuals to serve as patient advocates in case your preferred patient advocate is unable or unwilling to make decisions.

Continue to Level 2 below to learn more about additional considerations to include in your AMD. Once you have filled out the form, be sure to review the steps for completing your advance medical directive.

Optional Elements

You may choose to complete optional elements of an AMD if those items are important to you. Section 5 of the AMD booklet offers the opportunity to outline your preferences for treatment decisions, quality of life, and mental health care. 

Medical Treatment Decisions

Some people have strong feelings about what types of medical treatments or interventions they would or would not want attempted in their care. The Medical Treatment Decisions worksheet provides an opportunity to document what care you would or would not want attempted in any state of health. This section also allows you to specify the treatments you would or would not want attempted if you were very sick with a terminal or irreversible medical condition.

Quality of Life

People have different but strong feelings about what constitutes an acceptable versus an unacceptable quality of life, or state of existence. The Quality of Life worksheet provides an opportunity to document what permanent states of cognitive or physical functioning would be tolerable or unacceptable. Your responses will serve as a guide to your patient advocate to help make important medical decisions.

Mental Health Treatment

Some people have specific preferences with regards to their treatment preferences regarding psychiatric or mental health care.

Additional Instructions

Some people want to include additional or specific important wishes and preferences regarding their overall care if they become very sick. This section allows space and opportunity to make specific wishes or preferences known. See Level 3 below for some guidance and examples of what kinds of important details can be included.

Once you have filled out the form, be sure to review the steps for completing your advance medical directive.

Living with Serious Illness

Some people live with complicated medical circumstances which make it difficult for others to know how to care for you if you cannot tell them. Examples may include illnesses such as advanced cancer, kidney or heart failure, progressive Alzheimer’s or dementia. 

Most advance directive documents allow you to choose what type of medical treatments you would, or would not, want to receive. This can be difficult to know since we cannot predict what the future holds, but there are three categories to think about. 

Life Prolonging Care

People who choose life-prolonging care may feel it is important to live as long as they can, even if it means agreeing to procedures that may be painful or have a small chance of success.

Limited or Selective Medical Care

Those who choose limited medical care may feel it is important to live as long as possible but not if it means being in pain. They may want to avoid procedures like CPR that can be painful and are not likely to work.

Comfort Care

People who choose comfort care may feel it is more important to be comfortable than to live as long as possible. They do not want CPR. They do want treatment that focuses on their comfort. They want to avoid being in pain or kept alive artificially, even if it means they might miss a chance to live longer. 

Additional Resources

Additional resources are available for those who would like to create a more detailed and personalized AMD. 

• Munson Healthcare's Advance Care Planning Workbook walks you through planning and provides worksheets to help you consider what's important to your own sense of quality of life, your general treatment, and communication preferences related to your care.
• The Tool Kit for Health Care Advance Planning by the American Bar Association Commission on Law and Aging offers very detailed thought exercises that can serve as a more nuanced guide to help your patient advocate to make medical decisions for you.
• MI-POST is a form you complete with your medical provider. It is a physician order that should be honored wherever you receive care. This form gives seriously ill or frail people more specific direction over their health care treatments compared to advance directives and more options than Do Not Resuscitate (DNR) orders, such as:
  • "Take me to the hospital" or "I want to stay here"
  • "Yes, attempt CPR" or "No, don't attempt CPR"
  • These are the medical treatments I want..."
  • This is the care plan I want followed..."