Table.

Recommended Modifications to Advance Directive Laws to Improve Clinical Effectiveness^*

Barrier	Recommendation
Poor readability	Allow wide acceptance of diverse advance care planning tools and oral directives Eliminate mandatory legal language Mandate that forms be written in plain language at a 5th-grade reading level, and consider using pictures Mandate translation of forms into patients’ native languages, and pilot-test these forms in target populations
Durable power of attorney for health care restrictions	Allow isolated patients the option of choosing a care provider as a surrogate Allow same-sex and domestic partners to act as default decision makers Eliminate restrictions on the authority of surrogates
Execution requirements	Universally accept oral advance directives Eliminate witness and notary requirements
Lack of reciprocity	Adopt nonrestrictive reciprocity laws
Religious, cultural, and social inadequacies	Include language concerning shared or group decision making and cultural, religious, and social options in statutes

^*Many of these provisions are included in the Uniform Health-Care Decisions Act.