✅ Reviewed for accuracy and relevance by Deanna Cooper Gillingham, RN, CCM, FCM on June 26, 2025.
Case managers educate clients on and assist with advanced care planning to ensure their wishes will be honored if they are unable to speak for themselves. Advance directives must be drawn up while the client is competent and are only used if the client is incapacitated or deemed incompetent to speak for themselves.
Advance directives come in two forms:
- Documents that designate who will make healthcare decisions on behalf of the client (Healthcare Power of Attorney)
- Documents that specify what medical treatment should be given or withheld (Living Will, Do Not Resuscitate)
Healthcare power of attorney
Also known as a medical durable power of attorney, this type of advanced directive stipulates who will make healthcare decisions on behalf of the client if they are unable to do so themselves. This person is known as the surrogate decision-maker or healthcare proxy.
Living will
A living will is a legal document that states which specific life-sustaining medical treatments a person wishes to receive or have withheld if he or she becomes terminally ill or in a permanent vegetative state.
Common treatments addressed in a living will include:
- Mechanical ventilation
- Dialysis
- Tube feedings
- IV fluids
- Antibiotics
- CPR
Do Not Resuscitate / Allow Natural Death
Do Not Resuscitate (DNR) and Allow Natural Death (AND) are types of advance directives that indicate the person does not want CPR attempted. It is important to note that:
- States may have specific requirements for advance directives
- Names of advance directive legal documents may vary between states and organizations
- Advance directives only take effect when a person becomes unable to make his or her own decisions
Content adapted from CCM Certification Made Easy, 4th Edition by Deanna Cooper Gillingham, RN, CCM, FCM (2025) and used with permission from the Case Management Institute. Purchase your copy at CCMCertificationMadeEasy.com.
