End-of-life planning: Medical treatment

If you were in an accident or had a sudden serious illness, who would make decisions about your medical care if you couldn’t? In most cases, your immediate family members would probably make these decisions. Do they know your wishes?

You can plan ahead by communicating your wishes about medical care through end-of-life planning. With a legal document called an advance directive, you can be clear about how you would make these decisions.

Advance directives are especially important as we get older. A terminal medical condition may render you incapable of making a decision for yourself, such as whether you want to continue on life support. An advance directive lets your health-care providers and family know what you want.

The three most common advance directives are:

• A living will
• A durable power of attorney for medical decisions
• A Physician Orders for Life-Sustaining Treatment (POLST)

Why have an advance directive

For those who wish to peacefully pass in our own homes, an advance directive can greatly increase the chances of this kind of natural death. Your loved ones know what you want, so they are less likely to experiment with treatments and medical choices that keep you in the hospital during your last days. Advance directives reduce stress on your family and decrease the risk of family disagreements about your medical care.

An advance directive has the potential to save you, your estate and survivors from substantial medical bills. Life-extending procedures may cost thousands of dollars per day and can quickly eat away at funds – even if you have health insurance and substantial assets. In the end, the goal is not to reduce the resources spent on your medical care, but to use those resources appropriately.

Creating a living will

A common form of advance directive is a living will. A living will outlines what you want to have done should you face a terminal medical condition or are in a coma or similar non-responsive condition and can no longer make your own decisions. The document directs which medical procedures you want or don’t want if you have a terminal condition but can’t speak for yourself.

A living will can be as specific or general as you prefer. Many people include specific instructions about:

• Life-support machines
• Pain medications
• Intravenous feeding/nutrition
• Chemotherapy
• Blood transfusions
• Hydration (water)
• Hospice care
• “Do not resuscitate” (DNR) orders (to not attempt CPR if your heart or breathing stops)
  • You do not need a living will to have a DNR order because it can be attached to your medical chart
• Organ donation (most states allow you to declare yourself an organ donor on your driver’s license)

Remember, a living will goes into effect only if you are terminally ill and become incapable of making your own decisions. As long as you can make your own decisions, your personal choices take precedence over a living will – even in the middle of an illness.

Because life situations and medical technology change constantly, it is a good idea to periodically review your living will to make sure it still accurately reflects your wishes.

Appointing a decision-maker for medical decisions

The second type of advance directive is appointing someone as power of attorney for medical decisions (also called an agent), allowing you to have a representative to make decisions about your health care. When you create an advance directive, discuss it with your designated power of attorney as well as your loved ones. The more family members know in advance about your wishes, the better.

A health care power of attorney document applies to a broader spectrum of life circumstances than living wills. The document allows your agent to make or closely help with many decisions on medical care, including hospital and nursing care admissions. Issues such as finances and payment usually are controlled by a power of attorney for finances. Learn more about the types and roles of the decision-makers in your life: Who will act for you.

POLST programs

A Physician Orders for Life-Sustaining Treatment is a more recent advance directive. These forms have been shown to be very effective advance directives that are used typically close to the end of life, determining where a person dies and how a person dies. A POLST complements other advance directives by spelling out which specific treatments a person wants, such as feeding tubes or a breathing machine. After you and your doctor sign it, it becomes part of your medical record and is readily available if you are ill.

Questions for getting started:

• When should I begin writing my living will?
• If death was imminent, what treatment might I want? What wouldn’t I want?
• What treatment would I want if I was in a permanent coma, had significant brain damage or a terminal illness?
• Have I discussed these wishes with my family?
• How does my perspective on advance directives reflect my faith, personal values, concern for my family and sense of stewardship?