University at Buffalo

Advance Directives

Advance Directives provide guidance for medical decision to made after the person becomes incapacitated. There are two general categories of directives: proxy and instructional. An instructional directive provides specific details about preferences for treatment decisions that might be anticipated. A living will is an example of an instructional directive.

A proxy directive simply identifies the individual that is trusted to make surrogate decisions if the person is not capable of making decisions. A heath care proxy and a durable power of attorney for health care are examples of proxy directives.

Depending on the jurisdiction, local laws may grant specific legal status to either kind of directive. When it does so, it usually requires a specific format and specific procedural rules. Even when there is no law however, such directives have moral force as representation of the person's wishes in regard to future health care.

As a practical matter, it is often difficult for people to anticipate the specific medical decisions that may arise in the future. A proxy directive will still permit decision making by a trusted agent, but it is important that the surrogate at least be familiar with the wishes, values and attitudes of the patient. Frank discussions between patient and agent over time are helpful. An instrument which further facilitates this is a values history.


Comments or Suggestions to Jack Freer jfreer@buffalo.edu
Return to UB Center for Clinical Ethics Home Page.
Last Revised: 02/10/07