Planning for the Future
According to the American Journal of Preventive Medicine, nearly three-quarters of Americans do not have an advance care directive, which stipulates the care you want to receive if you are dying, in a permanent coma, or incapacitated and cannot speak for yourself.
For both your peace of mind and your family’s, it’s well worth pushing past any discomfort and doing some advance care planning so that your wishes are respected at the end of your life. Before you have a conversation on this subject though, make sure you’re up to speed on the various types of life-sustaining treatments including CPR, dialysis or a ventilator. Then ask yourself some questions, like the following:
- Would you want to be on a ventilator if an illness left you in a permanent coma?
- Under what circumstances would you want doctors to use CPR if your heart stopped?
- How would you feel about a feeding tube if you stopped eating due to advanced dementia?
Once you decide how you want your care handled, it’s time to have your first discussion with your family and/or close friends as well as your doctor.
The next step is to write down your care plan with the type of treatment you would and would not want in an advance directive, a legal document typically comprised of a living will and a durable power of attorney (POA) for healthcare.
A living will describes under what conditions an attempt to prolong life should be started or stopped. Remember, refusing aggressive medical treatment is not the same as refusing all medical care. You can always receive comfort or palliative care, such as antibiotics or pain medicines, if you are dying or permanently unconscious.
You can also create a durable Power of Attorney for healthcare (also known as a healthcare POA) in addition to or instead of a living will. This document allows you to authorize someone to make all your healthcare decisions if you no longer can. (Advance directives can only be implemented after a physician fully evaluates the person's condition, meaning that emergency personnel must do what is necessary to stabilize a person for transfer to a hospital.)
It’s vital that you choose a healthcare power of attorney who is familiar with your values and wishes around quality of life. He or she should be someone you can count on to ask questions of doctors and to advocate on your behalf. It’s also wise to assign someone as a backup POA. Take heed that your POA can no longer act on your behalf if you ever do regain the ability to make decisions.
Other Advance Care Planning Documents
You can also prepare separate documents to express your wishes about specific medical issues such as blood transfusions, organ and tissue donations, or cremation and burial. Consider a DNR (do not resuscitate) order, which tells medical staff that you do not want them to try to return your heart to a normal rhythm if it stops, and a DNI (do not intubate) order that stipulates that you do not want to be put on a breathing machine.
Some states are developing or using an advance care planning form known as POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment). These forms, which must be completed by your doctor, allow you to provide more detailed guidance about your medical care preferences.
A Few Last Tips
Keep in mind that advance directives completed in one state may or may not work in another state. To be certain your wishes are followed, you may complete advance directives for each state in which you spend a significant amount of time. Although you don’t need a lawyer, your documents must be properly witnessed.
Do not store your advance directives in a safety deposit box as other people may not be able to access them in an emergency. Give copies to your healthcare power of attorney and alternate POA as well as to your doctor. If you have to go to the hospital, give staff a copy to include in your records.
Keep in mind that advance planning is not a one-time event but rather an ongoing process. You should review your advance directives periodically, especially if you get married, separated, or divorced; your health status changes, or something happens to your POA.
*The provided information is for information purposes only. Please seek legal or professional advice before moving forward.