HEALTH CARE DIRECTIVES & LIVING WILLS

Although death is an inevitable part of life, many of us remain reluctant to face this fact and put off planning for our end-of-life care. Consequently, many families are left with the stress and heartache of trying to agree on the best way to care for a terminally ill loved one who is no longer able to make his or her wishes known. Thinking about your end-of-life choices today can improve your quality of life in the future and ease the burden on your family. An Advance Health Care Directive, also known as a Living Will, is a document that ensures your end-of-life wishes will be carried out. Discussing your wishes with loved ones and preparing an Advance Health Care Directive offers the best assurance that decisions regarding your future medical care will reflect your own values and desires.
 

The Advance Health Care Directive makes clear your desires for medical treatment, and allows you to appoint someone to make decisions for you when you cannot make them for yourself. Anyone over the age of 18 should have an Advance Health Care Directive in place. The directive should be written with a great deal of consideration, and discussed in detail with your doctor. The Advance Health Care Directive provides a clear statement of your wishes about your choice to prolong your life or to withhold or withdraw treatment. You can also choose to request relief from pain even if doing so hastens death. A standard Advance Health Care Directive form provides room to state additional wishes and directions and allows you to leave instructions about organ donations.
 

While most people would prefer to die in their own homes, it is more common for terminally ill patients to die in the hospital, often receiving ineffective treatments that they may not really want. The opinions and wishes of the dying person are often lost in all the chaos, and consequently their friends and family members can become embroiled in bitter arguments about the best way to care for the patient and consequently miss sharing the final stage of life with their loved one. 

It is almost impossible to know what a dying person’s wishes truly are unless the issues have been discussed ahead of time. Planning ahead with an Advance Health Care Directive can give your principal caregiver, family members, and other loved ones peace of mind when it comes to making decisions about your future health care. It lets everyone know what is important to you and what is not. While sad, talking about death with those close to us is a way to ensure greater quality of life, even when faced with a life-limiting illness or tragic accident. When your loved ones are clear about your preferences for treatment, they’re free to devote their energy to care and compassion.

* Who do you want to make decisions for you if you are not able to 

   make your own decisions about financial matters? About health care 

   decisions? (The same person may not be right for both).

* What medical treatments and care are acceptable to you? Are there 

   some that you do not agree to?

* Do you wish to be resuscitated if you stop breathing and/or your

   heart stops? 

* Do you want to be hospitalized or would you prefer to stay at home or 

   somewhere else if you are seriously or terminally ill? 

* How will your care be paid for? Do you have adequate insurance? 

   What might you have overlooked that will be costly at a time when 

   your loved ones are distracted by grieving over your condition 

   or death? 

Source: Family Caregiver Alliance

Advance Health Care Directives and Living Wills are not complicated, they can be short, simple statements about what you want done or not done if you can't speak for yourself. However, the content of these statements can be complex and should be thought through very carefully. It is important to discuss your wishes with family members as well as legal, health, and other appropriate professionals when preparing such a document. It is particularly important to talk with everyone who may be involved in the future about your wishes because in times of stress, others may confuse their own wishes with your wishes.

Choices about end of life are important for all adults – not just for the older population. Not only does an Advance Health Care Directive let your voice be heard about what you want, but it also relieves others of making these decisions for you. 

Speak With Your Physician

It is important that you discuss your health care desires with your physician. He or she is likely to be the one caring for you when your instructions become relevant and is much more likely to honor requests that have been communicated directly. 

Your physician can:

* Answer any questions you may have 

* Help you phrase your requests in a way that makes sense to medical 

   professionals

* Point out any illogical or inconsistent features of your requests – 

   Sometimes refusing one kind of treatment makes it illogical to expect 

   to receive another kind of treatment. Your physician can smooth out 

   some of these "rough edges" and help make a consistent and 

   coherent directive.

* Tell you if there are aspects of your requests that he or she cannot 

   honor because of personal, moral, or professional constraints. 

Speak With Your Family

Despite your best efforts to plan for all eventualities in an Advance Health Care Directive, actual events may not "fit" your directives. Therefore, it is important that you discuss your desires with family 

and friends.

Your family can:

* Help clarify your directives on the basis of recollections of specific 

   discussions under specific circumstances. If you have discussed your 

   wishes with a number of people, it is more likely that those wishes will 

   be honored. 

* Help avoid unpleasant scenes and confrontations when you are 

   incapacitated. While family members may have little legal authority to 

   make decisions for incapacitated patients, they often feel they have 

   moral authority. They may be confused by statements not previously 

   shared with them, and may even try to contest your wishes legally if 

   they feel your choices are not “in your best interest."

Source: The Living Will: A Guide To Health Care Decision Making 

(SUNY, Buffalo)

The California Medical Association has designed forms for people to complete on their own by filling in the blanks. While you are not required to seek legal advice to prepare an Advance Health Care Directive, it may be a good idea to do so to ensure that the actual instructions for your wishes are stated accurately. It has to be absolutely clear in order to be enforceable. 

Advance Health Care Directive forms for your state are available via:

* State healthcare association websites

* Community and senior services organizations

* Attorneys handling wills, estates, probate, and Elderlaw matters

* Geriatric care managers

* Hospitals or hospice programs

Once you have completed your Advance Health Care Directive, it may be necessary to have it notarized depending on who witnesses your signature – follow the instructions on the document in accordance with your state laws. Providing many trusted individuals with copies of your Advance Health Care Directive will insure that your health care wishes are met in the event that you cannot express your wishes for yourself. 

Make sure you keep the original copy of the Advance Health Care Directive in a place that can easily be found, and give copies to:

* Your chosen health care proxy (with directions on where to find 

   the original)

* Family members or other loved ones

* Your primary care physician, hospital, or health care institution. (Ask 

   that a copy is placed in your medical record and make sure your 

   doctor will support your wishes).

* Anyone named in the directive

* A copy can also be sent to your attorney or kept in a safety deposit 

   box or anywhere else you may keep copies of a Will or other

   important papers. (Be sure that you have discussed the directive

   with the person you designate as your health care agent and that

   he or she understands your wishes and the responsibilities involved).

It is best to think of Advance Health Care Directives as a work in progress. Circumstances can change, as can your values and opinions about how you would best like your future health care needs to be met. Directives can be revoked or replaced at any time as long as you are capable of making your own decisions. It is recommended that you review your documents every few years and after important life changes and revise your directives to ensure that they continue to accurately reflect your situation and wishes.

Re-examine your health care wishes every few years and whenever any of the “Five D’s” occur:

1. Decade – when you start each new decade of your  life.
2. Death – whenever you experience the death of a loved one.
3. Divorce – when you experience a divorce or other major family change.
4. Diagnosis – when you are diagnosed with a serious health condition.
5. Decline – when you experience a significant decline or deterioration of an existing health condition, especially when it diminishes your ability to live independently.

Source: American  Bar Association

Once you have revised your Advance Health Care Directive, it is important to discuss the changes with your physician and family members, and to notify everyone who has copies of your old directive forms.