If you’re like 25- to 30-percent of Americans, you’ve taken the time to prepare a living will, putting to paper your end-of-life wishes. Your forethought is probably a relief to your next of kin who otherwise might have been burdened with making life-or-death medical decisions for you.
However, a common problem that’s now being regularly encountered is, many living wills may not be specific or thorough enough to guide family members in every possible situation, leaving them struggling to decide what to do with your life in the balance.
Before we go any further, let’s review what a living will is. Also known as an advanced directive or health care directive, a living will is a written legal document that spells out medical treatments you would and would not want to be used to keep you alive. It includes issues such as pain management, if you have a terminal illness, or the amount of care you would receive if you are in a permanent vegetative state. A living will does not become effective unless you are incapacitated; until then, you will be able to say what treatments you do or don’t want.
A living will should not be confused with a living trust, which is used for holding and distributing a person’s assets to avoid probate. That’s an entirely different matter, and another article.
So what’s at issue? It’s science!
In the last two decades, medical technology has grown by leaps and bounds. Let’s say Grandpa Joe had a stroke. The consequences of Grandpa Joe’s stroke (treatment/recovery/rehab) are different in 2015 than if Grandpa Joe’s stroke occurred in 1985 or 1995, and that’s all due to advances in medicine. Because of these advancements, it makes it difficult for doctors to predict whether a patient will survive or for how long; what treatments might be involved in sustaining life; and what quality of life could be expected should the patient survive. It’s very likely a living will created 10 or more years ago would not address some of these concerns.
If you are in a condition where you can no longer express your preferences about treatment, decisions will be made for you by others. And you may know of an instance where this has happened.
Whether you’re creating a living will for the first time or updating a pre-existing one, here are some important questions to keep in mind:
- Who do you want to make health care decisions for you when you can’t? Typically, a husband and wife have the authority to make decisions for each other. However, if the parents are of advanced age, a child or close family friend may be authorized.
- What kind of medical treatment do you want and which treatments would you decline?
- How comfortable do you want to be?
- How do you want people to treat you? These three points go hand-in-hand because they deal with your wishes, and address matters such as: do you want to receive resuscitation (CPR), mechanical ventilation, tube feeding and palliative care? A simple living will may not address these concerns but a detailed living will will ask if you want to receive water (or even ice chips!) or pain medication, which might be issues you hadn’t considered. And going one step further, a living will may state you wish to die at home, not in a hospital or nursing home setting. Again, that may be a matter you hadn’t considered.
- What do you want your loved ones to know? This point may include organ and tissue donations, or donating your body for scientific study. To help avoid any confusion or misunderstandings, you may want to state that you wish to be an organ donor, because life-sustaining provisions will need to be temporarily used until the organs are removed. And if you’re donating your body, have you contacted a medical school, university or donation program to register? If so, the family needs to know where that information is kept.
It’s recommended to have an attorney create a living will. When he does, the attorney will explain the options with you. And remember, you can decide to do one option today but, after thinking about it or researching the matter further, you may decide to change your mind. It’s perfectly okay! The attorney will have to create replacement paperwork.
After your living will is created, remember to keep the original in a safe but easily accessible place. Talk to family members and/or close friends to let them know about your health care wishes. Your primary care physician also should have a copy on file. And if you’re a frequent traveler, keep a copy with you in case something happens.
No one likes to discuss end-of-life matters with family; it’s an uncomfortable conversation. But if you don’t, family members can be confused and conflicted and end up having emotional exchanges you would never wish upon them. Stop and think: is that something you want your family to go through? You owe it to your family to share your wishes…in writing.