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If you want to make changes, you must create a new form, distribute new copies and destroy all old copies. Specific requirements for changing directives may vary by state. You should discuss changes with your primary care doctor and make sure a new directive replaces an old directive in your medical file.

Health care providers can do so when: Your decision is contrary to the conscience of your individual medical services provider. Your decision goes against the policy of the health care institution. Your decision would result in ineffective health care or violates the provider's health care standards.

In the near future it is expected the illness will result in permanent unconsciousness from which the person is unlikely to recover or death. Examples of terminal conditions may include but are not limited to advanced cancers, multiple organ failure, or some massive heart attacks and strokes.

How long will my advance health care directive last? There is no time limit for these documents. Generally they will last until you change them or terminate them. You may change them at any time and update the form from time to time by simply completing new documents.

Advance directives do not expire. An advance directive remains in effect until you change it. If you complete a new advance directive, it invalidates the previous one. You should review your advance directives periodically to ensure that they still reflect your wishes.

Chiefly in acute or emergent situations, in elective procedures, and in intensive care at the end of life, an ethical dilemma surrounding advance directives arises frequently, and this may partially extend from a unique set of goals and values found commonly among surgeons.

Although advance directives may stimulate discussions and reduce the stress of surrogate decision making (5–8), well-documented controversy exists over their clinical effectiveness, including their inability to affect clinicians' and families' understanding of patients' preferences and the type of care received (9).

The doctor could override your advance directive. Any other person would not have the opportunity to override your advance directive. If you have concerns about this, you can discuss them with your appointed healthcare agent and doctor, so they fully understand your wishes.

Unintended negative consequences of advance directive legal restrictions may prevent all patients, and particularly vulnerable patients, from making and communicating their end-of-life wishes and having them honored.