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It's never too early to make a living will

It could happen at any time. Walk across the street and get hit by a truck. Hop into your car and encounter a drunk driver. Suffer a sudden, acute illness and find yourself hospitalized. Any of these could end your life. Or, they could leave you mentally or physically incapacitated.

If it happened to you, would you be ready? Would you have your affairs in order so your doctor and family would know what your health care wishes are? If not, perhaps it's time to consider some sort of advance directive so you can control your own health care even if you can no longer express your wishes.

Contrary to what you might think, living wills and other advance health care directives aren't only for the elderly. Disaster can hit anyone at any age. The time to make your health care decisions for the future is now -- while you can. Not only will you assure yourself that your health care wishes will be followed, you will take some of the burden off family members who might be left to make those health care decisions for you.

A will to live by
We tend to use the term "living will" rather loosely. Actually, when we speak of living wills, we're speaking of a two-pronged approach to making our health care wishes known called advance directives. Preparing a living will is one part of a comprehensive advance directive plan. The other is preparing a durable power of attorney for health care. Together, these two documents can give you peace of mind regarding your health care wishes for the future and are an important part of your estate planning.

A living will is a legal document in which you direct your physician regarding the withdrawal of life support if you become ill and have a terminal condition, are in an irreversible coma or a persistent vegetative state. All states recognize the legality of a living will, though you should check your state for the particulars. In a living will, you can specify exactly what your doctor is to do if you, in his or her opinion, cannot recover from your illness or accident and are no longer capable of making your own decisions. At the very least, your living will should address what your physician is to do about:

 

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  • Cardiac resuscitation
  • Mechanical respiration (ventilator)
  • Antibiotics
  • Artificial nutrition (feeding tube)
  • Artificial hydration (IV)
  • Pain medication and oxygen therapy
  • "Do Not Resuscitate" orders

Before making your living will, decide how you feel about these issues. Would you want the doctor to withhold nutrition and hydration, for example, if you had a stroke? If you were terminally ill? If you were a victim of dementia or senility? If so, you need to prepare your living will to deal with those possibilities.

You can make your living will as specific as you like regarding these situations. In other words, you can direct your physician that, if you cannot get well, you don't want to be resuscitated nor do you want to be placed on a ventilator for artificial breathing. Be very specific about how you feel about artificial nutrition and hydration as states differ in their laws in that area. Also, be specific if you want "comfort measures." Comfort measures include anything to make the end easier for you although they will not prolong your life. Examples of comfort measures are pain medication and oxygen therapy. You can even draw up your living will to reflect that you do indeed want life support measures to be taken and under what circumstances.

Passing on the power
Even though a living will gives direction to your physician, it is also advisable to have a durable power of attorney for health care. This document differs from a living will in that you appoint an agent, or proxy, to make medical decisions for you in accordance with your wishes. Be sure that the person you appoint as your agent is ready and willing to serve in that capacity. The decisions that person has to make and enforce will not be easy. For example, withholding artificial nutrition and hydration from a loved one is very difficult for most people. Be sure that your agent understands the implications of serving in your stead and is prepared to make and enforce difficult decisions. Often, two individuals are appointed in this capacity. The second individual is appointed in case the first choice cannot or does not want to serve.

The durable power of attorney for health care is perhaps even more important than the living will. Living wills generally address the desires of patients in the most dire of circumstances. If you have a health care agent appointed through a durable power of attorney, however, that individual can make other types of health care and treatment decisions for you if you are not competent to do so yourself. Examples would be day-to-day care and treatment options. In addition, living wills often need interpretation. Your health care agent, presumably someone who knows you well, would be able to supply that interpretation.

Even though you can prepare these documents yourself, you're safer if a qualified attorney prepares them. The attorney will know the specifics of the law within your state. After preparing your advance directive, you need to supply copies to your physicians and your health care agent so they will be available if needed. If you move to a different state, most states recognize the advance directives of other states. You can change the terms of your living will and durable power of attorney for health care at any time.

Tips to remember
In summary, here is a short list of tips on preparing your living will and advance directive:

  • Determine your feelings about living wills and what they mean.
  • Decide on the specifics that you want your living will to address such as resuscitation and artificial nutrition.
  • Decide if you want to specify comfort measures in your living will.
  • Decide if you want to prepare a durable power of attorney so a person close to you can help make your medical decisions if you cannot do so.
  • Choose one or two individuals to serve in the capacity of your health care agent.
  • Name the agents in the durable power of attorney and be specific about the types of decisions they can make as well as your own desires.
  • Have an attorney prepare your living will and durable power of attorney and distribute copies to your physician and health care agents.

Most individuals have their living wills and durable powers of attorney prepared at the same time they prepare their last will and testament. But don't wait too long. Anything can happen at any time and you want to be in control of your health care decisions even if you become incapacitated.

-- Posted: April 6, 2004

 

 

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