You Need A Living Will And A Health Care Proxy

Would you want to be kept alive if a car accident or some other tragedy propelled you into a “persistent vegetative state” — that is, your brain waves stopped but you could be kept alive on a respirator? When asked, about 95% of adults say no. No matter how you feel about treatment choices, making your own decisions about them is one of your rights. Take advantage of it by expressing your wishes in writing while you can.

One of the biggest mistakes people make is signing only a living will.

There are two documents you can use to make sure you keep control over your life: a living will and a durable power of attorney for health care (also called a health care proxy in some states). Lawyers call them advance directives. If you don’t have a written advance directive, doctors will make decisions about care aided by input from those close to you, selected from a list created by the state where you are hospitalized. This can lead to court fights if those called upon disagree.

Even if you’ve told your friends and family your beliefs about end-of-life medical care, any lawyer will tell you that spoken wishes are only evidence in what could become a very expensive and complicated court proceeding. Signing an advance directive doesn’t rob you of your decision-making power. Any advance directive goes into effect only if you cannot make decisions yourself. If you are able to communicate your wishes in any way, even by batting your eyelids once for yes and two for no, you call the shots, and as long as you can call the shots, you can also revoke or change advance directives.

Durable Power of Attorney For Health Care

A power of attorney for health care generally is considered the best way to provide for your health care because you can give another person as much power as you wish to decide on medical treatment anytime you are unable to make your own health care decisions. You also can indicate any end-of-life-care you want, such as a desire for pain relief even if it may shorten your life. And you should state an affirmative decision to forgo tube feeding and administering of water, if that is your desire. Any competent adult can be your proxy (or agent or attorney-in-fact), but it should be someone you trust implicitly who knows as much as possible about your wishes. It can be a spouse or other family member or even a friend under most state laws. But under no circumstances can it be your attending physician.

Living Will

A living will, also known in some states as a directive to physicians or a health-care directive, lets you decide if you want your body to be kept functioning even if there is no hope that you will ever recover. A living will generally makes it clear that you do not want to prolong the process of dying. Even so, instructions provided in living wills regularly require interpretation by doctors.

One of the biggest mistakes people make is signing only a living will. Living wills generally go into effect only if a patient is terminally ill and death is expected in a short time (sometimes defined as six months), or is in a permanent state of unconsciousness (called a “persistent vegetative state”). Therefore a living will can’t help if a patient is temporarily unconscious or, significantly, is in the end stages of Alzheimer’s and would require a feeding tube for nutrition.

The durable power for health care is commonly included in even basic estate plans today. A lawyer might charge $100 or so to prepare a health care power of attorney or living will separately. Many states have updated their laws to permit documents that combine the living will and the durable power. If your current estate plan includes both a living will and a durable power of attorney for health care, have them reviewed to make sure they do not contradict each other. In addition be aware that in some states at the end of life the living will takes precedence over the power of attorney. If you don’t want that to happen, arrange for changes in your documents.

You can download your state’s forms and instructions for living wills and durable powers of attorney for health care free from www.caringinfo.org. But before completing and signing any document, make sure you understand and agree with its provisions. If you don’t agree, discuss changes with your lawyer or doctor. Keep the original readily available (not in a safe-deposit box) and make copies for your family, your doctor (who should put a copy in your medical file), a hospital when you are admitted (bring a copy with you) or a nursing home, for example. Just having a form won’t ensure that your wishes are carried out. Make sure your proxy and your doctor understand and support your wishes and you tell everyone who needs to know about your documents.

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