An end-of-life discussion is not a topic many people want to spend time thinking about in-depth. After all, imagining a future in which you may be sick or hurt is hard, especially when you're still feeling vibrant and healthy — regardless of your age.
But as part of your estate planning process, it's critical to consider what will happen if you're unable to make decisions due to injury or illness. It's crucial not only for your assets and finances but also for your health.
That's where an advance health care directive comes in. This type of living will can help inform others about your wishes and take some of the worry and strain off of your loved ones during a stressful time. Here's what you need to know about a living will.
What Is an Advance Health Care Directive?
An advance health care directive, also called a living will, is a legal document that lays out your end-of-life wishes. This document states, in writing, your decisions for any medical treatment, including the care you wish to have or want to avoid.
You may think, "Why do I need this? I'm young and healthy." But consider it this way: You have a will to designate who cares for your children (if you have any) and where your assets go if something happens to you. It's there as a safeguard and is a key part of the estate planning process.
An advance health directive acts similarly. Life is unpredictable, and a young and healthy person could get in a terrible car accident, leaving them incapacitated, just as someone older may struggle with an illness at the end of their life. The directive is there as a way for you to still have a voice throughout the process and ensure your wishes are followed.
What Is a Health Care Proxy?
A living will is one type of advance directive that involves your health; another is a health care proxy, also known as a durable power of attorney.
A health care proxy is a designated person in charge of making medical decisions based on your wishes. As with a will, naming a health care proxy is a legal document. Without one, and if you don't have an advance directive, medical professionals will usually have your closest family member, typically a spouse or children, make medical decisions based on their advice.
In many cases, this family member may also be your health care proxy, but make it clear in the document if you'd prefer someone else. Sometimes, people choose a third party to follow their health care directives to remove stress from loved ones during a difficult time.
How Does an Advance Health Care Directive Work?
This directive typically comes into play if you are incapacitated due to an accident or illness, have dementia, are in a coma or are terminally ill. Your directive will serve as a guide for your doctors and the health care professionals providing your care and treatment.
Some of the things you can consider for your health care directive include:
- Life supporting or life-prolonging treatments such as intubation.
- If there are any pain medications you do or do not want.
- If you'd want to undergo more surgeries to try to extend your life.
- If you want to be considered for organ donation.
- If you want palliative care.
As you create your document, you can pick and choose your preferences — it is not an all-or-nothing situation. For example, if you're okay with extra surgeries and intubation for up to 30 days but no longer than that, you can note that preference in your directive. If you'd prefer no life-support treatments at all, you can note that, too. Ideally, the more clearly you can document your wishes the better. That will help doctors make the right medical decisions and avoid confusion.
Do not intubate (DNI) and do not resuscitate (DNR) orders are electives you may want to include in your advance directive. However, you can tell your doctor your wishes for these two specific orders at any time, and they will be added to your file — a legal document is not needed.
Medical professionals are required by law to ask if you have any health care directives. Typically, advance directives most often come into play in hospitals, nursing homes and other care facilities. However, keep in mind that in emergencies, such as car accidents, an EMS will try to stabilize you to go to the hospital, even if you have a directive. If you don't have a directive, your primary care doctor and your family will need to make the medical decisions about your care together.
What Are the Benefits of Having an Advance Health Care Directive?
There are a number of reasons why thinking about these end-of-life scenarios, though scary, may benefit you and your loved ones over the long term. For example:
- A directive is easy to create. Many states have pre-formatted templates on the Secretary of State websites you can fill in and print out.
- It takes any decision-making out of the hands of your family. Having clear instructions on your wishes can help them when they're worried or unsure about your care.
- It helps you prepare ahead of time for the unexpected, especially if you're otherwise young and healthy and get into an accident or have a sudden illness.
- It lets your doctors and other medical professionals know you've given thought to your care, so they can better provide assistance to meet your wishes.
- It gives you a voice when you otherwise would not be able to speak. You'll know your preferences are being followed.
While it may be a hard discussion to have with your loved ones, thinking about how you want to be cared for at the end of your life may be a comfort to you. It will allow you to be on the same page, and you can have some peace of mind that if the unexpected were to happen, you've taken steps to prepare ahead of time. Hopefully, that may relieve some of the anxiety from your loved ones during a very upsetting time.
A Few Things to Keep in Mind
A living will can be changed or updated at any time. If you decide to make any changes, create a new form rather than amending your current one. Once you have a directive, be sure to let your primary care doctor know. Ask them to keep a copy in your file and update your electronic medical records so hospitals can store and find the information. Also, give copies to your health care proxy and attorney.
Schedule time for review every few years. Most people review their directives every five years. Make sure you check it after any significant life changes such as expanding your family, going through a divorce or being diagnosed with an illness.
Finally, pay close attention to the rules and regulations around living wills and health care proxies in your state. Depending on where you live, a health care proxy and living will may be combined into one document. In addition, different states have various rules around proxies, so make sure you review those with your lawyer as you create your documents.
While thinking about the end of your life may be difficult, having a health care directive and proxy can ensure your final wishes are met.