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A Comparison of State Advance Directive Documents

^a William S. Middleton Memorial Veterans Hospital, Geriatric Research, Education and Clinical Center, Madison, WI
^b Department of Medicine, University of Wisconsin School of Medicine, Madison
^c Partnership for Caring, Inc., New York, NY

Correspondence: Gail Gunter-Hunt, MSW, William S. Middleton Memorial Veterans Hospital, Geriatric Research, Education and Clinical Center, 2500 Overlook Terrace, Madison, WI 53705. E-mail: gail.hunt{at}med.va.gov.

Decision Editor: Laurence G. Branch, PhD

Purpose: Advance directive (AD) documents are based on state-specific statutes and vary in terms of content. These differences can create confusion and inconsistencies resulting in a possible failure to honor the health care wishes of people who execute health care documents for one state and receive health care in another state. The purpose of this study was to compare similarities and differences in the content of state AD documents. Design and Methods: AD documents for 50 states and the District of Columbia posted on the Partnership for Caring website were reviewed. States and regions of the country were compared for type or types of documents used and issues included in AD documents. Results: Three states had statutory living will documents only; however, these states did allow for appointment of a health care agent for limited end-of-life decisions. Three states had statutory durable power of attorney for health care documents only, 32 had both statutory living will and durable power of attorney for health care documents, and 13 had statutory forms which combine both types of directive in one document (advance health care directives). Of 8 identified key issues, those addressed by at least 90% of states were designation of a proxy, personal instructions for care, general life-sustaining measures, and terminal illness. When document types were compared, advance health care directive documents included more of the key issues than did living will or durable power of attorney for health care documents (p < .001). Implications: This variability suggests a need for national dialogue to standardize some provisions of AD documents.

Key Words: End-of-life treatment decisions • Advance decision making • Medical ethics

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