Future health planning issues
Decisions regarding your health continue throughout your life. Even at the end of life, there are important decisions to be made. That doesn’t mean, though, that you should wait until your final days to make these crucial decisions or to let your wishes be known to others.
One of the most important steps that you can take in the prime of your life — when you’re healthy and able to have a discussion with your family — is to let your thoughts be known regarding your final days — how you’d like to spend them and whether you’d like measures to be taken to extend your life, if possible.
It may be difficult to think about such things, but it’s important that you do. Letting your wishes be known helps ensure that if you’re incapacitated or dying, matters will be taken care of in the manner you prefer. And it also benefits your family by providing guidance in medical and ethical issues that are potentially divisive and costly.
Advance directives
With the advent of modern medications, surgical techniques and life-sustaining technologies, medicine has become increasingly capable of prolonging the life and easing the pain of seriously ill people. Sometimes, death due to natural failure of the heart, lungs or other organs can be postponed with life-prolonging measures.
One of the most important things that you can do with your doctor and your family is to have a frank discussion about how you wish to be treated when you don’t have the capacity to make decisions for yourself, such as when you’re unconscious or too sick to communicate.
Under these circumstances, an advance directive can guide your family and caretakers. An advance directive is a legal document that spells out the types of medical treatments and life-sustaining measures you do or do not want. It may also specify an individual that you’ve appointed to make medical decisions on your behalf.
In some states this type of document may be known by a different name, such as a health care directive or health care declaration.
If you’re older than age 18 and are being admitted to a hospital, nursing home, hospice or home health care agency that receives Medicare funds, the institution is required by federal law to ask whether you have an advance directive. That information is documented in your record. In the absence of an advance directive, a doctor will rely on your next of kin for guidance.
The institution must also give you written information about your right, under state law, to accept or reject medical treatment. Whether or not you have an advance directive, federal law requires the institution to provide all individuals the same treatment options.
The most common types of advance directives are a durable power of attorney for health care (a person) and a living will (a document). A combination of the two provides maximum personal participation in the face of medical situations that require difficult decisions.
A durable power of attorney for health care
One of the most important actions you can take is appointing someone you trust to make health-related decisions for you should you become unable or unwilling to do so, giving this person legal authority to act on your behalf. A durable power of attorney for health care identifies this person, also called a proxy, in writing.
Your proxy helps ensure that your wishes aren’t misinterpreted or ignored. When selecting someone to serve as your proxy, choose a person you’re comfortable with acting as your representative. He or she should fully understand your medical care philosophy and wishes and agree to serve in representing them. It may also be helpful, but not necessary, if this person lives close to you.
The reason it’s so important to have a proxy is because it’s impossible to predict all of the things that might require a decision in the future, or what the circumstances will be when those decisions need to be made.
Your proxy can respond specifically to possible questions and decisions that your condition may create. For example, you may say you don’t want a feeding tube. But what many people mean is that they don’t want a feeding tube if death is near and inevitable. There are circumstances in which a temporary feeding tube could be very helpful to recovery.
The only way to tease out these nuances is to have a conversation with your proxy about your overall goals for health care. For example, your overall goal may be to avoid medical interventions that will prolong your life unnecessarily if there is no reasonable chance of recovery.
Don’t confuse a durable power of attorney for health care with a financial power of attorney. A financial power of attorney allows a person you authorize to manage your money and property if you aren’t able to do so.
A living will
A living will is a document you create to specify which medical treatments you want or don’t want at the end of your life. Because no one can anticipate all of the possible circumstances surrounding his or her death, it’s hard to be specific in living wills. For example, you may state that you don’t want heroic procedures to extend your life when death is imminent, but then your doctor has to make certain distinctions as necessary: Is the use of a respirator a heroic measure? What about a blood transfusion?
The question becomes increasingly complicated as new technologies develop and yesterday’s heroic treatments become routine. For doctors, one of the biggest challenges is keeping patients and family members informed of ever-changing life-sustaining technologies and the personal impact of those treatments.
Nonetheless, a living will is a place where you can record your overall health care goals and intentions.
In determining your wishes, think about your values and core beliefs. When would you consider it appropriate to refuse life-sustaining measures? Would it matter what stage of an illness or injury you were in? Would it matter what your prognosis was or if your condition was improving?
To help you get started in planning your living will, here are the main potential life-sustaining treatments to consider:
Also decide if you would like to donate your organs for possible transplantation or your body for scientific study.
A living will by itself carries only moral force in stating your preferences. To give legal authority to living wills, most states have passed statutes, often called natural death acts. In these states, the statutes interpret the extent of the authority and the legal force of the living will.
The statutes aren’t uniform among states. To ensure that your living will conforms to your state’s requirements and will be followed, be familiar with the appropriate laws in your state before you prepare your living will or let an attorney help you.
Do not resuscitate order
A do not resuscitate (DNR) order is a request to not have cardiopulmonary resuscitation if your heart stops or if you stop breathing. Your resuscitation requests may be included in your living will, or a DNR order can stand on its own — your doctor can put a DNR order in your medical chart.
Preparing your directives
You may want to enlist the help of an attorney to help you prepare an advance directive, although this isn’t necessary. Your doctor or hospital staff can give you the necessary forms and provide resources explaining the relevant state laws. You can also obtain state-appropriate forms on a variety of websites, such as the National Hospice and Palliative Care Organization.
Other possible sources include your local library or state medical, hospice or bar association.
The forms should come with directions for filling them out. If you have any questions, ask your doctor or attorney. Before naming someone to make health care decisions on your behalf, discuss your decision with that person. He or she may be required to sign an acceptance form to act as your proxy. Usually, you’ll need to have witnesses or a notary sign the forms.
Once you’ve filled out the necessary forms, make sure that your proxy and other important people in your life — your spouse, adult children, doctor, lawyer — have copies of the forms or know how to get them. Also let them know who is your designated proxy. At home, keep a copy in a place where it’s easily accessible by others. Some people also keep a copy in a safe-deposit box.
Changing your directives
You can update your advance directive at any time. In fact, it’s probably wise to take a look at your advance directive on a periodic basis, especially if your health status changes.
To change an advance directive, a witness, notary or both may be required. Check the requirements in your state. If you move to another state, you may want to update your directive, even though most states will honor directives from other states. Be sure to discuss major changes with your proxy and to give updated copies to your proxy and other copy holders.