Living Wills: What Are They and Who Needs Them?
“If you have been diagnosed with or are at risk for certain medical conditions, you may wish to address them directly. In outlining a living will, it can be beneficial to discuss your options with your primary care physician, who can answer questions and suggest scenarios you might not think of on your own.”
Who needs a living will? If you are 18 or older, you do. Many people aren’t sure what this document is, and may not know the differences among a living will, healthcare proxy or Do Not Resuscitate order. While these tools pertain to your care in a hospital or health care facility if you are unable to express your wishes directly, they play different roles.
Anthony D. Criscuolo, CFP®, certified financial planner with Palisades Hudson Financial Group’s Fort Lauderdale, Florida, office, says, “Living wills are important for adults of any age, even those in good health, so it’s never too early to start planning.”
A living will is a legal document that outlines what medical treatment you would prefer in case you are incapacitated and unable to relay your wishes to your healthcare providers and family members. It can helpful relieve the burden of decision-making for family members and caregivers, and can reduce disagreement or confusion about the choices you would want others to make on your behalf. The American Bar Association notes that a living will is appropriate for situations in which using life-sustaining treatment or intervention “may prolong your life for a limited period of time and not obtaining such treatment would result in your death.”
It should outline, for example, at what point you would choose to refuse extensive medical intervention. You may decide that if your medical providers deem you do not have a realistic chance of recovery, you want to be kept comfortable through palliative care. You may specify that you’d like food and water, since those, if delivered via intubation, are considered medical treatment, notes Dana Cody, executive director of Life Legal Guardians, a group that seeks to help people protect life from conception to natural death.
“Topics you may wish to address in a living will include pain management options, the use of prolonged life support, your preferences regarding resuscitation and your desires regarding organ donation, among others. While a Do Not Resuscitate order does not require a living will, it is a good idea to mention it in that document if you have one,” said Criscuolo. “If you have been diagnosed with or are at risk for certain medical conditions, you may wish to address them directly. In outlining a living will, it can be beneficial to discuss your options with your primary care physician, who can answer questions and suggest scenarios you might not think of on your own.” Further options to discuss with your physician are dialysis, antibiotic or antiviral treatment, or the donation of your body for scientific study.
A medical or healthcare power of attorney is an advance healthcare directive in which a specific person is named to make decisions if you are incapacitated. Depending on the state in which you live, this may be called a healthcare proxy, agent, surrogate, agent-in-fact, or patient advocate. This person acts for you as the executor of your will does, and should be carefully chosen. Make sure that you and this individual agree in terms of philosophy of end-of-life care and care choices in cases of incapacity, which can happen at any age. Other advance healthcare directives include a Do Not Intubate order, which prohibits the use of mechanical ventilation.
Advance healthcare directives should be in writing; in some states, a witness or notary signature may be required. The American Bar Association and the National Hospice and Palliative Care Organization websites provide links to state-specific forms. Review these completed forms with your physician; keep the originals in a safe, easily accessed place and provide copies to your doctor, health care agent and family members. You can change your directives at any time, but be certain to provide copies of any changed documents to the appropriate persons. If you have a change in marital status, a new diagnosis or a change in wishes, consider reviewing your documents and updating them to make sure they reflect your current status and decisions.
Forty-five states either provide for a POLST, or Physician Orders for Life Sustaining Treatment, which gives seriously ill patients more control over their end-of-life care, or have such a program in development. The form name may differ by state, but in effect it is the documentation of advance care conversations between the patient, family members and health care providers, and assures the patient that their wishes will be respected. As with advance directives, the POLST can be changed or cancelled.
It may be enough to discuss this difficult topic with your loved ones, but it is safest to put your wishes in writing. “A living will, like other advance directives, should be handled carefully to ensure it is legally binding,” says Criscuolo. “As with a traditional will, it is better not to wait until something goes wrong to make sure your wishes have the force of law behind them.” Making these decisions before the time of need can empower you and your loved ones to have the level of control you want regarding your choices.
Sources: americanbar.org, bloomberg.com, capolst.org, mayoclinic.com, nhdd.org, nhpco.org and polst.org.