Health Care Directives & Living Wills

What is a Health Directive?

A Health Care Directive, also known as a Living Will, is a document that ensures your end-of-life wishes will be carried out. Although death is an inevitable part of life, many of us remain reluctant to face the fact that we’re not going to live forever and plan for our end-of-life care. Consequently, many families are left with the stress and heartache of trying to agree on the best way to care for a terminally-ill loved one who is unable to make his or her wishes known.

Thinking about your end-of-life choices today can improve your quality of life in the future and ease the burden on your family. Discussing your wishes with loved ones and preparing an Advance Health Care Directive offers the best assurance that decisions regarding your future medical care will reflect your own values and desires.

The health directive makes clear your desires for medical treatment, and allows you to appoint someone to make decisions for you when you cannot make them for yourself. Anyone over the age of 18 can have a health directive in place. The directive should be written with a great deal of consideration, and discussed in detail with your doctor.

The Advance Health Care Directive provides a clear statement of wishes about your choice to prolong your life or to withhold or withdraw treatment. You can also choose to request relief from pain even if doing so hastens death. A standard advance directive form provides room to state additional wishes and directions and allows you to leave instructions about organ donations.

Importance of an Advance Health Care Directive

While most people would prefer to die in their own homes, the norm is still for terminally-ill patients to die in the hospital, often receiving ineffective treatments that they may not really want. Their friends and family members can become embroiled in bitter arguments about the best way to care for the patient and consequently miss sharing the final stage of life with their loved one. Also, the opinions and wishes of the dying person are often lost in all the chaos.

It’s almost impossible to know what a dying person’s wishes truly are unless the issues have been discussed ahead of time. Planning ahead with an Advance Health Care Directive can give your principal caregiver, family members, and other loved ones peace of mind when it comes to making decisions about your future health care. It lets everyone know what is important to you, and what is not. Talking about death with those close to us is not about being ghoulish or giving up on life, but a way to ensure greater quality of life, even when faced with a life-limiting illness or tragic accident. When your loved ones are clear about your preferences for treatment, they’re free to devote their energy to care and compassion.

End-of-life issues in an Advance Health Care Directive

Specific issues relate to the end of one's life. These include:

• Whom do you want to make decisions for you if you are not able to make your own, both on financial matters and health care decisions? The same person may not be right for both.
• What medical treatments and care are acceptable to you? Are there some that you fear?
• Do you wish to be resuscitated if you stop breathing and/or your heart stops?
• Do you want to be hospitalized or stay at home, or somewhere else, if you are seriously or terminally ill?
• How will your care be paid for? Do you have adequate insurance? What might you have overlooked that will be costly at a time when your loved ones are distracted by grieving over your condition or death?
• What actually happens when a person dies? Do you want to know more about what might happen? Will your loved ones be prepared for the decisions they may have to make?

Source: Family Caregiver Alliance

Creating an Advance Health Care Directive

Advance Health Care Directives and living wills are not complicated, but the content can be complex and should be thought through very carefully. It can be short, simple statements about what you want done or not done if you can’t speak for yourself. It’s important to discuss your wishes with family members, legal, health or other appropriate professionals when preparing such a document. It is particularly important to talk with everyone who might be involved about your wishes because in times of stress, others may confuse their own wishes with your wishes.

The California Medical Association has designed forms for people to complete on their own by filling in the blanks. While you are not required to seek legal advice to prepare an advance health care directive, it may be a good idea to do so to ensure that the actual instructions for your wishes are stated accurately. It has to be absolutely clear to be enforceable.

Speak With Your Physician

It is important that you discuss your health care desires with your physician. He or she is likely to be the one caring for you when your instructions become relevant and is much more likely to honor requests that have been communicated directly. Your physician can:

• Help you phrase your requests in a way that makes sense to medical professionals and can answer any questions you may have.
• Point out any illogical or inconsistent features of your requests. Sometimes refusing one kind of treatment makes it illogical to expect to receive another kind of treatment. Your physician can smooth out some of these “rough edges” and help make a consistent and coherent directive.
• Tell you if there are aspects of your requests that he or she cannot honor because of personal, moral, or professional constraints.

Speak With Your Family

Despite your best efforts to plan for all eventualities in a health care declaration, actual events may not “fit” your directives. It is therefore important that you discuss your desires with family and friends.

• Your family can often help clarify your directives on the basis of recollections of specific discussions under specific circumstances.
• If you have discussed your wishes with a number of people, it is more likely that those wishes will be honored.
• Discussions with family members can help avoid unpleasant scenes and confrontations when you are incapacitated. While family members may have little legal authority to make decisions for incapacitated patients, they often feel they have moral authority. They may be confused by statements not previously shared with them, and may even try to contest your wishes legally if they feel your choices are not in your “best interest.”

Source: The Living Will: A Guide To Health Care Decision Making (SUNY, Buffalo)

Advance Health Care Directive forms

Advance Health Care Directive forms for your state are available via:

• State healthcare association website.
• Community and senior services organizations.
• Attorneys handling wills, estates, probate, and Elder law matters.
• Geriatric care managers.
• Hospitals or hospice programs.

What to do with a completed Advance Health Care Directive

Once you have completed your advance directive, it may be necessary to have it notarized depending on who witnesses your signature - follow the instructions on the document in accordance with your state laws. Providing many trusted individuals with copies of your advance directive will insure that your health care wishes are met in the event that you cannot express your wishes for yourself.

Keep the original copy of the Advance Health Care Directive yourself in a place that can easily be found, and give copies to:

• Your chosen health care proxy (with directions on where to find the original).
• Family members or other loved ones.
• Your primary care physician, hospital, or health care institution. Ask that a copy is placed in your medical record and make sure your doctor will support your wishes.
• Anyone named in the directive.

A copy can also be sent to your attorney or kept in a safety deposit box or anywhere else you may keep copies of a will or other important papers. Be sure that you have discussed the directive with the person you designate as your health care agent and that he or she understands your wishes and the responsibilities involved.

What happens if I change my mind?

It’s best to think of Advance Health Care Directives as a work in progress. Circumstances can change, as can your values and opinions about how you would best like your future health care needs to be met. Directives can be revoked or replaced at any time as long as you are capable of making your own decisions. It is recommended that you review your documents every few years or after important life changes and revise your directives to ensure that they continue to accurately reflect your situation and wishes.

When to Reassess Your Advance Health Care Directive

Re-examine your health care wishes every few years or whenever any of the “Five D’s” occur:

1. Decade – when you start each new decade of your life.
2. Death – whenever you experience the death of a loved one.
3. Divorce – when you experience a divorce or other major family change.
4. Diagnosis – when you are diagnosed with a serious health condition.
5. Decline – when you experience a significant decline or deterioration of an existing health condition, especially when it diminishes your ability to live independently.

Source: American Bar Association

Choices about end of life are important for all adults—not just for the older population. Not only does an Advance Health Care Directive let your voice be heard about what you want, but it also relieves others of making these decisions for you.

Changing your Advance Health Care Directive

Once you have revised your Advance Health Care Directive, it is important to discuss the changes with your physician and family members, and notify everyone who has copies of your old directive forms.