A comparison of state advance directive documents

Area of Science:

• Health Law
• Bioethics
• Public Health Policy

Background:

• Advance directive (AD) documents are state-specific, leading to potential confusion and non-compliance when individuals receive care in different states.
• Variations in AD content can impede the accurate execution of healthcare wishes.

Purpose of the Study:

• To compare the similarities and differences in the content of state-specific advance directive documents across the United States.
• To identify variations in document types and included provisions.

Main Methods:

• A review of advance directive documents from all 50 states and the District of Columbia was conducted.
• Documents were analyzed for types (living will, durable power of attorney for healthcare, combined advance healthcare directives) and key issues addressed.

Main Results:

• 32 states utilize both living will and durable power of attorney for healthcare documents, while 13 offer combined advance healthcare directives.
• Key issues like proxy designation, personal care instructions, life-sustaining measures, and terminal illness were addressed by over 90% of states.
• Combined advance healthcare directive documents incorporated more key issues compared to living will or durable power of attorney documents (p <.001).

Conclusions:

• Significant variability exists in state advance directive statutes and document content.
• A national dialogue is necessary to standardize certain provisions within advance directive documents to improve consistency and compliance.