Clarifying Your Wishes



Most of us have heard of the "Living Will."  It is a document in which individuals write out their health care wishes in advance, in case severe illness or injury ever prevents them from making their wishes personally known.  Certain states may also refer to living wills as "declarations," or simply as "health care instructions."

Many people have also heard of "Medical Powers of Attorney" -- or "Powers of Attorney for Health Care", or "Health Care Proxy" documents, as they are called in some states.  These documents are used to name someone you trust to make health care decisions for you, if you are ever unable to speak for yourself.  Collectively, living wills and medical power of attorney documents are known as "Advance Directives" -- because they are used to record your personal "directives" (i.e., instructions) in "advance" of future need.

In recent years, many complaints about these documents have been heard.  Certainly our researchers -- having worked for decades with of advance directives in university hospitals, community hospitals, major hospital chains, and in HMO settings as well as in other medical and clinical settings -- have heard frequent complaints.  One of the most frequent criticisms has been: 

"Well, I know what I want, but I just don't know exactly what to say to my family.  I mean, I want them to do the right thing for me, and they want that, too.  But it's hard to make my wishes clear and the standard advance directive from my state just doesn't seem to offer any real help." 

Thus, in 1994 our researchers took up the problem of how to meaningfully improve advance directives, and they diligently pursued this goal over the next decade and beyond. 

Numerous studies were carried out.  Input was obtained from two research foundations, three university-based Human Research Subjects Committees, a national government-run health research entity, a hospital-based Institutional Review Board, and a number of professional committees and research work groups.  During this time hundreds of living wills and medical powers of attorney documents were collected (representing more than one hundred different styles and formats), along with a great variety of other advance directive literature.  Further, the specific advance directive statutes for every state in the union were tediously reviewed, along with those of the District of Columbia and most major United States territories.  Finally, more than 6,000 articles in medical journals, legal publications, research reports, books, and main-stream media publications were gathered and studied. 

From this extensive information database were gleaned the best ideas available --including policies, legal guidelines, recommendations and requirements -- as related to advance directives and their use.  These early findings were then presented to a multitude of additional professional reviewers.  They included:

  • Physicians from many relevant specialties, including Geriatricians, Intensivists,  Hospitalists, Palliative Care and Pain Management specialists, Emergency Medicine specialists, and others
  • Nurses and various allied and administrative health care specialists, including geriatric nurses, intensive care and emergency medicine nurses
  • Paramedics
  • Medical administrators
  • Bioethicists
  • Medico-legal administrators
  • Elder law attorneys
  • Sociologists
  • Medical social workers
  • Psychiatric specialists, and
  • Many others.
Each offered important input and further suggestions and direction. 

Finally it seemed that we had at last assembled all the essential elements necessary for the design of a truly comprehensive and highly effective advance directive.  To our knowledge, no other group or organization has ever gone to these great lengths. 

Even so, it still seemed that if our endeavors ended here they might yet fall short of a most necessary and important goal:  ensuring that the needs and concerns of the public were also fully represented, as well. 


With this in mind, a culminating "Lifecare Project" was designed, organized and carried out.  Over the next four years more than 1,000 lay persons participated in an extended formal study for the public refinement of a comprehensive advance directive document.  This experience was profoundly enlightening.  Numerous areas that had been assumed to be of little importance (or not thought of at all) emerged.  Concerns related to health care outcomes, patient and family needs, finances, and personal independence were revealed, along with many others. 

Whenever the research identified yet another issue that a majority of the public found important, it was refined, adapted and included.  In this way all key concerns expressed by of a majority of  participants were identified and integrated into a truly comprehensive advance directive document -- one that specifically met the greatest needs of the public, not just those of medical and legal staff. 

At last, there was but one final obstacle to overcome. Each state, territory, and U.S. district has unique statutes, codes, laws, and court rulings governing the design, content, and use of advance directives.  Therefore, if these documents were to be of any real value, they needed to be crafted to meet the legal criteria of each and every state, district, and territory of the nation. 

This final process was extraordinarily taxing and time consuming.  It required diligent revisions, reconfigurations, and restructuring of the core research materials previously derived in ways to ensure that essential legal criteria were met while still preserving the crucial research content.  At last, however, that work has been completed. 

From this lengthy research process, extending over more than a decade, has emerged the Lifecare Advance Directive, along with other important related documents, information, and materials.  It is our belief -- and our research confirms -- that there exists no more comprehensive, useful, or effective advance directive document anywhere by which to better preserve your personal interests and liberties, and through which to meet your individual and family needs and goals. 

Your Lifecare directive has been specifically designed to accommodate any perspective that you may have -- whether that be the refusal of medical treatments and procedures in specific health situations that you find personally intolerable, and/or to document your desire to receive medical treatments and interventions in any health conditions that you fear others might easily overlook or dismiss. 

If you take personal planning seriously, the Lifecare Advance Directive is essential for you and for those you love. 

To Order Your Lifecare Directive

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Read about additional key considerations that should be in every advance directive on our "Enriched Content" page.  You may also download a brief (one page) informative PDF brochure to read and share with others here.  

To better understand why you need a Lifecare Directive, download a FREE PDF copy of our 21-page booklet "Should I complete an Advance Directive?" by clicking here

Researchers and medical educators may want to purchase the 32-page, 199- footnote e-book, "Should I Use a Shorter Standard Directive."  It outlines the development of the Lifecare Advance Directive, and reviews all essential advance directive content. 

More serious researchers may also want to obtain the 355-page e-book, "Strengthening Advance Directives." It offers more than 900 topic-specific footnotes and further scholarly material.  It also provides an in-depth look at advance directives, their development, history and short-comings, as well as proposed solutions and specific research and findings completed in preparing the Lifecare Advance Directive and related materials. 

Both of these e-books can be further reviewed in the Professional Resources section, and obtained by download or in a softbound format by mail order through the Ordering page, leading to the web shopping area. 


Note:  If you have a loved one who is no longer able to complete a standard advance directive (due to loss of decision-making capacity), you should consider obtaining a "Representative Advance Directive."  For more information on Representative Directives, applicable laws, and how to obtain a copy, click here.  

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