How to Take Control of Your End-of-Life Care
Many people have definite ideas about life-prolonging measures such as mechanical ventilators and CPR. Yet as many as 80% of the U.S. population have not yet created living will, or a legal document that outlines what type of end-of life care you wish to receive.
Living wills, also called advance directives, speak for you if you become incapacitated. Originally, they were used to indicate to medical professionals whether individuals wanted their lives prolonged through artificial means. People now use them to express much more, including their preferences for artificial feeding, pain treatment, and organ donation.
While thinking about end-of-life issues can be upsetting, it’s a good idea to have a living will no matter what age you are; anyone 18 or older can create one. A living will can:
- Protect your family from having to make difficult choices on your behalf.
- Prevent conflict or confusion by designating someone to carry out your wishes if you become unable to do so.
- Keep you from receiving medical care you don’t want.
Making Difficult Decisions
The first step in creating a living will is to consider the type of care you want in the event of illness or injury. Many patients find the easiest way to make decisions about end-of-life treatments is to discuss them with a physician. Your age, the nature of your ailment and whether there is the possibility of a cure might be important factors for you.
“In determining your wishes, think about your values, such as the importance to you of being independent and self-sufficient, and what you feel would make your life not worth living,” the Mayo Clinic suggests. “Would you want treatment to extend life in any situation? Would you want treatment only if a cure is possible?”
While it’s impossible to plan for every possibility, you should at minimum make some choices about the following treatments. As you consider each one, ask yourself three questions:
- Do I want to receive this treatment?
- For how long?
- Are there certain circumstances in which I would want it and other circumstances in which I would not?
Resuscitation. If your heart stops, health care workers are required to try and restart it for you unless your living will includes a do-not-resuscitate (DNR) order. You can choose whether you want receive cardiopulmonary resuscitation (CPR) or electric shocks from a defibrillator to stimulate your heart.
Mechanical ventilation. If you can’t breathe on your own, medical staff will typically place you on a machine that will do it for you. In the past, heart-rending legal battles have ensued over patients in a permanent vegetative state being kept alive on ventilators.
Palliative care. In the event that you become terminally ill, you can outline what type of pain treatment you want to receive.
Nutritional and hydration assistance. If you are unable to eat, your body can receive nutrition and fluids intravenously or via a tube in your stomach.
Dialysis. Should your kidneys fail, you can be hooked up to a machine that will remove the waste from your blood.
The next step in creating a living will is to designate a health care agent who can make decisions on your behalf. Nearly a third of people are unable to make their own health care decisions at the end of life, a study in the New England Journal of Medicine found. Your agent, also called a health care power of attorney, is legally required to carry out the preferences in your living will and does not have to be the same person who is designated to handle your monetary affairs.
Creating a Living Will
You can create your own advance directive with or without an attorney. Each state has different requirements for advance directives, so it pays to do a little research beforehand. If you’re interested in creating a living will but don’t want to spend a lot of money, here are a couple of options:
Five Wishes at AgingWithDignity.org. This website allows you to draft your own advance directive using low-cost forms that are legally binding in 42 states. Make sure your location is on the list, or else you’ll need additional forms from your state to make it official.
LegalZoom.com. After you fill out a simple online questionnaire, this affordable website will draft and send you a living will.
Once you’ve written your living will, the final step is to distribute it. In a study of 200 patients, 50% of those who created living wills placed the only copy in a safe deposit box, where health care workers could not access it. In such cases, doctors have reported patients being resuscitated against their will because the legal documents were not available.
To ensure your wishes are carried out, it’s crucial that you not only discuss your living will with your family but that you supply copies to your physician, your designated health care agent and other key family members.
For more information about living wills and end-of-life planning, check out Valley of Life’s new eBook, The Funeral Preplanning Guide.
Tags: advance directive, end-of-life planning, health care agent, living will, the funeral preplanning guide
May 27th, 2010 at 5:36 am
Thanks for writing on this important subject.
Oregon has a specific Advance Directive form to be used in this state instead of the national one. Links to that form and the POLST — Physician Orders for Life-Sustaining Treatment, which is signed by your healthcare provider — along with a brief description of each, can be found on the Oregon Medical Association site: http://www.theoma.org/page.asp?navid=288
Most hospital and hospice Chaplains can help you consider how your worldview and what is deeply important to you relates to these decisions. They can help you fill out the Advance Directive so it reflects what you want and don’t want. Many are available for a consultation with you even if you are not currently a patient in the facility they serve.
Another thought: Once you have filled out your Advance Directive, you can have it scanned into your electronic medical record at any of the facilities you might be taken to in an emergency situation. (If you don’t yet have an electronic medical record at a particular facility, they will create one for you.) Just be sure that if you do that, and later fill out a new form with updated decisions, to get your new form to all the facilities that have the previous one!
(Could you make the type larger in this Comment box, please?)