It's always difficult to talk about a prolonged illness, and even harder to talk about death and dying. But as we get older, we come to realize that the unexpected does happen, and at these times, having our wishes carried out becomes that much more important to us.
A living will, or an advanced directive outlines your preferences regarding end-of-life care. All adults, regardless of age, should have an advanced directive. Having one will assure that your specific wishes concerning medical care are carried out.
What advanced directives do
Basically, they are your voice when you are unable to speak for yourself, like when faced with a serious illness or accident. Advanced directives contain written instructions spelling out your medical care preferences.
Your doctor and family can consult your advanced directive if you are in a coma, or are unable to make your own decisions. These written instructions help to reduce confusion or any disagreements that could arise among family members.
The different types of advanced directives
A living will is a written legal document that spells out the types of medical treatment and life-sustaining measures you want, or don't want. This might include mechanical breathing (using a respirator or ventilation), or the use of feeding tubes or resuscitation efforts.
Depending on the state where you live, these documents may be called Health care declarations, or a Health care directive. In Virginia, they are called living wills.
The Medical or health power of attorney (POA)
The POA is also a legal document. It is different from a living will because it designates an individual, called a health care agent or proxy to make medical or health care decisions in the event you are unable to do so yourself.
The medical POA is not the same as a Power of Attorney that authorizes someone to make financial decisions for you.
Do Not Resuscitate (DNR)
The DNR order is a request to not have cardiopulmonary resuscitation (CPR) started if your heart stops or if you quit breathing. It's important to note that an advanced directive does not have to have a DNR order included, and you don't have to have an advanced directive to have a DNR order. Often, the doctor will put a DNR order in the patients medical chart.
Is a living will and a medical POA needed?
A living will won't cover every situation. This is a good reason to also have a medical POA. This way, you can designate someone to be your health care agent. That person will be guided by what's in the living will, and will also have the authority to interpret your wishes in those situations not covered in your living will.
It is worth mentioning again that having a written medical directive with your wishes outlined is one way to quell any indecision on the part of family members, especially if some are opposed to your wishes.
Choosing your health care agent
This is a very important part of your planning, and you shouldn't be guided by personal feelings, guilt or obligations to any one person. The agent doesn't have to be a family member either. Keep in mind that you may want someone different handling your financial matters.
The person chosen should be mature, levelheaded and comfortable with having candid conversations concerning your medical wishes. You will want to choose someone you trust, a person that has your best interests at heart, and fully understands what you want and will be able to act accordingly.
Quality of life and your personal values
You will want to think seriously about your own values and what "quality of life" means to you. You may be someone that thinks being independent and self-sufficient is important to living a good life, Do you want your life to be extended in any situation, or only if a cure is possible?
More importantly, would you want palliative care made available to ease your pain and discomfort if you are terminally ill. All these issues need to be addressed and your wishes concerning them need to be written down.
Donation of organs and final thoughts
While many people indicate they are an organ donor on their driver's license, it doesn't hurt to add your being an organ donor in your advanced directive. This is a good place to add any specific wishes you have, too.
Planning ahead will assure everyone concerned that you have made arrangements to receive the kind of medical care you want. This will alleviate any confusion and lessen the burden of making last minute decisions by loved ones.