Advance Directives

Advance care planning is important for anyone 18 or older. Without an advance directive, your loved ones may not know your wishes and may not have legal authority to make health care decisions for you.

The law does not authorize an adult’s parent, spouse, child, etc., to make health care decisions on their behalf. Without an advance directive naming someone to make those decisions, a family may need to get the court involved to appoint a legal guardian to make these decisions. This can be financially and emotionally costly to the family.

Advance care planning is a process that helps you think about your health care goals and values, consider future medical decisions, and discuss your wishes with your health care provider and those close to you.

An advance directive is the legal document used to make a written plan.

By law, a health care facility cannot refuse care. However, some specialty providers, such as neurosurgeons, may require an advance directive on file due to the risk of a procedure.

Yes, it would be important to have an advance directive document on file before any procedure in case of complications.

Keep your advance directive in a safe spot. You can keep your original with your important papers. You also should make photocopies to share with your health care agent, children, primary care provider and health system in your electronic medical record.

Having your advance directive in your medical record helps ensure your care team knows your wishes and who can make decisions for you in a medical crisis. Unfortunately, these documents are sometimes unavailable when needed, completed incorrectly or not kept up to date

If you have a My Marshfield Clinic account, you can attach your completed document to be routed to Health Information Management (HIM). The documentation must be saved on the device you are using to attach.

Once logged into your account, select Messaging – Inbox – Send a Message.

From there, select your name in the “on behalf of” section and enter “Legal Documents” from the drop-down menu in the “To” field. Add a free text subject or select a subject from the drop-down menu and add your attachments (advance directive documentation). You are required to enter text into the Message field and tap Send. 

You also have the option to email your completed advance directive to HIM at mclhim.consents@marshfieldclinic.org. If you prefer to send via mail, you can mail your to Health Information Management, HM2, Marshfield Clinic Health System, 1000 North Oak Avenue, Marshfield, WI 54449, to be filed with Marshfield Clinic Health System.

Marshfield Clinic Health System patients will have access through their My Marshfield Clinic account or can request through Health Information Management, HM2, Marshfield Clinic Health System, 1000 North Oak Avenue, Marshfield, WI 54449 Fax: 715-389-0564 Email: himspec@marshfieldclinic.org.

A living will does not name another person to make health care decisions in another’s behalf. It provides direction regarding life-sustaining procedures, but a living will is only effective if your condition is terminal or you are in a persistent vegetative state.

A power of attorney for health care (POA-HC) appoints someone to make health care decisions on your behalf. It is effective if you are determined to be incapacitated and can be reversed if you regain capacity. (Note: In Wisconsin, only a person’s legally authorized representative can provide informed consent to health care on behalf of another adult. Without a POA-HC, a guardian may need to be appointed by the court, which requires more time and money.)

Yes, they are different. A power of attorney for health care (POA-HC) is chosen by the patient. It is typically more private, involves no court oversight and allows flexibility in decision-making based on the wishes stated in an advance directive.

Legal guardianship is generally less private. It involves the court and may require ongoing reporting, including annual status updates.

Patients who have a legal guardian have been declared incompetent* in a court and are not able to complete an advance directive once guardianship of that person has been established.

*Note: "Incompetent" is the legal terminology and is determined by a court. "Incapacitated" is the medical terminology and is determined by two medical providers.

A health care agent is the person you would need to name on your advance directive. This person can make health care decisions for you when you can’t make your own choices. An agent may be needed if the person is incapacitated or is nearing the end of their life.

Choose someone you trust to make medical decisions on your behalf. A health care agent must be 18 or older and of sound mind. Your agent generally cannot be your health care provider, your provider’s employee, an employee of a health care facility where you are a resident or patient, or the spouse or domestic partner of any of those individuals—unless that person is also your relative.

Your health care agent should be someone you trust that is:

• Willing to accept the responsibility
• Willing to talk with you about goals, values and preferences for medical treatment
• Able to make decisions during difficult moments
• Able to follow through on your wishes, even if your agent doesn’t agree with them

Two doctors or health care professionals authorized under current state law need to examine and evaluate the patient to determine if the patient is capable of making health care decisions. If not, a statement of incapacity will be signed and attached to the current power of attorney for health care (POA-HC) document.

A health care agent makes decisions based on the person’s wishes and values. An agent may make the following choices for the person:

• Decide on tests, surgery and medicine
• Choose the patient’s doctor(s)
• Choose the location(s) where the person may receive care
• Decide to stop treatment
• Decide whether to share the patient’s medical records

If you have no advance care plan, then your family, friends and medical team will not have an understanding, or an appreciation of, your individual wishes related to your current and future health care. More importantly, if you do not participate in any advance care planning, then you may not have had an opportunity to truly consider your own wishes.

If you have no advance directive, your wishes regarding health care may not be known. More importantly, there will likely be no one who will have legal authority to make medical or health care decisions on your behalf without the court or legal system getting involved.

You can still write down the treatments you want or do not want. A health care agent can be a friend, a close neighbor or someone from work or church.

In Wisconsin, you must have your advance directive signed in front of two witnesses. You are unable to have it notarized. In other states, an advance directive can be signed in front of a notary public.

A witness must:

• Be 18 or older
• Not be related to you by blood, marriage, domestic partnership or adoption
• Not be your health care agent
• Not be financially responsible for your health care
• Not have a claim against your estate
• Not be your health care provider or your provider's employee at the time of signing

Other rules:

• Two witnesses are required to witness the principal's signature
• No notary is required in Wisconsin if you have two witness signatures
• Wisconsin exception: Social workers and chaplains may serve as witnesses, even if employed by the health care provider

It is recommended to review your advance directive annually or update when any of the “five D’s” occur:

• Decade – when you start each new decade of your life (i.e. 40, 50, 60, 70, etc.)
• Death (or Dispute) – when a loved one or a health care agent dies (or disagrees with your preferences)
• Divorce – when divorce (or annulment) happens if your spouse was named as a health care agent
• Diagnosis – when you or your agent are diagnosed with a serious illness
• Decline – when your health declines rapidly, especially when you are unable to live on your own, or when your agent's health declines

If your goals and preferences change, talk to your agent(s), your family, your provider and anyone else who has a copy of your advance directive. Then, complete a new advance directive.

If you change your mind regarding some of your wishes, complete a new form. Once the advance directive document is signed and witnessed, it is considered legal and cannot be changed. A new document must be completed to add, change or remove health care agents, or for any other changes to the document. The most current form on file will be used.

Each state may have different laws. You should check with your health care location to see if they have your advance directive on file.