End-of-Life Care: Living Wills and Advance Directives

While heated debate over health care and health care spending has raged in recent years, the debate has served an important role by raising the issue of end-of-life care in the American consciousness.

Modern medicine continues to develop new and extraordinary treatments that can extend life in situations that once meant certain death. At the same time, according to research, the lion’s share of health care spending in the U.S. goes to cover the cost of care for people in their last year of life, and much of that spending is aimed at artificially extending life when there is no practical hope for a cure.

The Choice Is Yours

No matter where you stand on the issues, the importance of taking a proactive approach to your own end-of-life care has never been clearer or more relevant. In the course of the health care debate, many Americans found themselves asking and considering questions such as:

  • Who should make decisions regarding end-of-life care?
  • What should those decisions be based on?
  • What are your wishes regarding your own end-of-life care? Do you want to be kept alive, even by artificial means, as long as possible? Or, in the event of a terminal or debilitating illness, would you prefer to refuse all artificial life support and die a natural death?

Such questions are highly personal, with no clear, right or wrong, answers. The only thing certain is that they shouldn’t be left to chance, yet we’ve all heard horror stories of dying individuals caught up protracted legal cases and families torn apart because they couldn’t agree on the best course of action when a loved one could no longer speak for herself.

Fortunately, there are legal means to put your health care affairs in order, just like your material estate. Terms like advance directive, living will, durable power of attorney for health care, and DNR refer to specific legal designations regarding end-of-life care. The following Q & A is meant to help you understand these terms; as in all legal matters, however, be sure to consult an attorney for definitive advice.

What is an advance directive?

An advance directive is any legal document that tells your health care providers the type of care you wish to receive should you become incapable of making medical decisions. Advance directives can include one or more of the following documents: living will, durable power of attorney for health care, and “do not resuscitate” order (DNR). Some examples of specific provisions you may wish to cover in your advance directive include

  • Mechanical ventilation
  • Nutrition and hydration
  • Dialysis
  • Organ donation

What is a living will?

A living will is a type of advance directive that specifically describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill.

What is a durable power of attorney for health care?

A durable power of attorney for health care (also known as a medical power of attorney) is another type of advance directive that designates someone to make health care decisions on your behalf, should you become unable to speak for yourself. The person you designate is known as your health care agent or proxy. It is possible to have both a living will and durable power of attorney, with the living will outlining your wishes and the durable power of attorney to cover any decisions not covered in your living will. (Keep in mind that a medical power of attorney is not the same as a power of attorney you designate to handle your financial matters.)

What is a “do not resuscitate” (DNR) order?

A DNR is yet another type of advance directive. A DNR simply states that you do not wish to undergo cardiopulmonary resuscitation (CPR) if your heart stops beating or you stop breathing. (In the absence of a DNR, medical personnel will always attempt CPR in the event of cardiac or pulmonary arrest.) If you haven’t executed a DNR form, you can tell your doctor to add a DNR order to your chart.

Make Your Wishes Known

After you’ve created your advance directives, the next step is to inform your loved ones of your wishes. Facing the inevitability of your own death isn’t easy, and many people find that this step is the hardest. The best approach is to have an open and honest discussion with your family.

If family members protest that such things are too “morbid” to talk about, be gentle but persistent. Explain to them why this is so important to you so they can understand. Tell your loved ones you want to make sure your wishes are carried out, and that you don’t want them to bear the responsibility of making the hard decisions for you. You may even be able to help them by encouraging them to make their own advance directives.

Your Experience

Have you encountered any pitfalls in completing advance directives? Have you experienced a sense of relief, knowing that you’ve made your wishes known?

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