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Patients have a legal and ethical right to make their own healthcare decisions, and the  patient Self-Determination Act requires healthcare facilities that receive Medicare funding to inform patients of their right to formulate advance directives. Although research has shown that family members experience far less stress when a dying patient has a living will or medical power of attorney, fewer than one in five adults has executed an advance directive.

As patient advocates, nurses can play a key role in encouraging patients to prepare such a document before they become gravely ill. To do that, however, you need a basic understanding of advance directives and your role.

Although terms may vary from state to state, a document in which an individual specifies his or her wishes—not to be maintained on artificial life support if there is no hope of a meaningful recovery, for example—is generally known as a living will. But no written statement can cover every eventuality, so a patient should discuss his preferences with a loved one, then sign a document—typically known as a medical power of attorney— authorizing that person to make medical decisions in the event that the patient becomes unable to make them himself. A copy of a living will or medical power of attorney, or both, should be placed in the patient’s medical record.

If family members disagree about following the expressed wishes of an incapacitated patient or a conflict over end-of-life care arises, you should notify the primary care provider and recommend a consultation with your facility’s ethics team. As a nurse and patient advocate, you may be instrumental in ensuring that your patient’s treatment wishes are followed.