New Hampshire Advance Healthcare Directive

An advance healthcare directive is also called a living will. This important document allows you to specify your wishes about medical treatment at the end of your life or in the event you are unable to make decisions.

Advance healthcare directives are commonly used in the following scenarios:

• Terminal illness

• Permanent coma

• Persistent vegetative state

• Traumatic brain injury

• Dementia or Alzheimer’s disease

• Other medical illnesses which impact mental capacity

Before the directive becomes effective for decision-making, your physicians must agree that you are unable to make decisions about your medical care. You also need to be in the medical condition that your state’s law requires, usually either with a terminal illness or in a permanent state of unconsciousness. Once these requirements are met, the healthcare providers working on your care will tailor your treatment to match your wishes stated in the document.

Advance healthcare directives are legal throughout the U.S. and you do not need a lawyer to create one. Your advance healthcare directive becomes legal as soon as you sign it (with the required witnesses).

If you are concerned about what would happen to you or how you would be treated in the event of a medical crisis, injury, or illness that left you unable to make decisions, an advance healthcare directive can put your mind at ease. This practical document can ensure that your wishes are understood and followed and even makes things easier for your family if they are struggling with difficult decisions about your care. Setting up an advance directive while you are healthy and competent ensures that the document will be valid and that your loved ones understand your wishes. In a medical emergency, it is crucial to be prepared to make decisions live, as situations can change rapidly and require immediate action.

Your advance healthcare directive can include your preferences about any or all of the following aspects of care:

• Resuscitation, including if you want CPR or electric shock stimulation

• Ventilation by mechanical device

• Tube feeding via IV or stomach tube

• Dialysis to remove waste from your system if your kidneys are not working

• Administration of antibiotics, antivirals, and other medications

• Palliative care, comfort care, and pain management including hospice care

• Tissue and organ donation wishes

Considering all of these factors ahead of time and incorporating the things that are important to you in your directive can give you peace of mind and ensure that your family members understand your wishes.

In general, an advance healthcare directive contains the following sections and information:

• A declaration section which states that you are in your right mind and aware of your options. This section expresses your legal right to make decisions about your care.

• The condition you must be in before you may be considered unable to make decisions and your wishes regarding the treatment of ongoing illnesses. If you are in a coma, not mentally competent, unconscious, or in another state, you can detail when the advance directive should be enforced.

• Your actual wishes and directions for care. This section could be long or short depending on your individual preferences. It includes directions for your doctor on what to do if you need to be resuscitated, what to do about palliative care or pain relief, and what specific actions or treatments you do not want, including ventilation, tube feeding, and resuscitation.

• The treatments you want to have if you are incapacitated and unable to express your wishes, detailed specifically so that your treatment team and family knows what to do.

• Your signature and the signature of your witnesses will need to be included.

The more specific you are in your advance directive and the more circumstances you outline, the easier the document will be for your healthcare providers and family to follow. You may also choose to appoint a healthcare agent (also called a proxy) in addition to creating your advance healthcare directive. This person is entrusted with making healthcare decisions for you if you are incapable of doing so for yourself and in case the circumstances in question are not covered in your advance directive.

You do not need an attorney to create your advance healthcare directive.

If you receive a different or new diagnosis or anything changes in your health or prognosis, then you should revisit your advance healthcare directive and amend it as needed. You will need to create new forms and redistribute and replace them with all parties involved.

Your advance directive should outline your wishes, but your doctors are not obligated to follow it. If your doctor has a conscientious objection to one or more of your instructions, he or she is not required to follow it. However, the doctor should transfer you to another provider who will comply.

The best way to ensure compliance with your wishes is to speak to your medical professional and healthcare team ahead of time and make sure they understand your advance directive and agree to follow it. Your family and healthcare agent can also help ensure that your wishes are followed, provided you supply them with the most up-to-date copy of your advance directive and talk to them about your specific wishes in advance.

No, a lawyer is not required for this document. While you do not need an attorney, you should make sure you understand all of the provisions and the consequences involved. Your physician can help explain your options.

Although an attorney is not required, you will need to read the document carefully and sign it. One or more witnesses and a notary may be required to witness you sign the document depending on your state.

No, notarization is one option, not a requirement. New Hampshire requires you to sign your advance directive in front of two qualified witnesses or a notary public or justice of the peace. Either method makes the document valid.

Yes. You can change or revoke your advance healthcare directive at any time while you still have the mental capacity to do so. If you create a new directive, give updated copies to your agent, your doctors, and anyone who has the old version.