Advanced Directives / Living Will

The Patient Self-Determination Act was passed as part of the Omnibus Budget Reconciliation Act of 1990 and took effect in December 1991. This Act requires health care providers to inform patients of their right to make their own health care decisions. The Act was intended to increase a patient’s control over his or her own medical treatment decisions. Today, the Act facilitates informed decision-making, a process that includes, but isn’t limited to, advance directives.

Advance directives include a living will, the durable power of attorney for health care, and the directive for organ donation. These are legal documents completed by competent adults and specify their choices regarding medical treatments if they become incapacitated. These documents also allow the patient to name someone to make choices for him if he can’t make the decisions on his own.

Advanced directives provide both legal and emotional advantages for you:

Your peace of mind that your wishes are carried out when you cannot communicate.

Clear directions for family and significant others about your wishes.

Clear directions for health care providers about your choices.

Your advance directive prevents, or reduces, family arguments at an emotionally difficult time because you have made your choices known to them. There is no added family burden of guess work.

Just as there is information that you can gather before you see an attorney about your will, there are preliminary steps you can take to prepare advance directives:

Obtain information about the types of life sustaining treatments available.

If you are currently ill, obtain information regarding the expected progress of your disease.

Discuss with your physician the expectations of your treatments and the risks of undergoing such treatments.

Decide which treatments you would or would not want to receive.

Document the types of treatment you would or would not like to receive if you no longer can communicate your choices.

Print several copies of the document and give one to your physician, your attorney and your chosen surrogates. Keep a copy for your own files.

Above all, make sure that your family and significant others are familiar with your values and spiritual beliefs. Let them know what life-sustaining treatments you do and do not want and under what circumstances you want all heroic medical measures stopped.

A living will spells out your choices about what life prolonging treatment should be provided or withheld when you are no longer able to communicate those choices for yourself. It is usually implemented either in terminal illness or permanent disability. Estate planning experts recommend that all adults prepare a living will. Estate planning should focus on you as a person, not just your assets. Decisions you make about your own health care are part of that.

For a living will to be valid, it must be written while you are competent and of sound mind. You will want to review your living will periodically to ensure that its provisions still reflect your wishes.

In conjunction with your living will, you need a durable power of attorney for health care, or health care proxy. This document allows you to designate the person you want to make health care decisions on your behalf when you are unable to do so. If you have no relatives or significant others who can represent you and carry out your wishes appropriately, a health care provider other than the attending physician can be named as a surrogate decision maker. An attorney can also function in this capacity.

The living will and health care proxy each has a distinct function in your estate plan. The living will provides guidance to health care professionals and loved ones about your wishes regarding life-sustaining treatments, while the health care proxy names the person who is responsible for making health care decisions on your behalf. It is wise to have a health care proxy drawn up by a lawyer to ensure that it conforms to your state laws and court precedents.

We associate the phrase “right to die” with the tragedies of Nancy Cruzan, Karen Ann Quinlan and Theresa Schiavo, but long- term legal battles can occur whenever there is no living will or health care proxy in place. These battles come with high emotional cost. Please talk to your doctor about end-of-life care so you can make informed decisions about what you do or do not want. Then make these wishes clear to your loved ones now so they don’t have to guess, or argue, later.

A Word About Organ Donation

Organ donation is a sensitive subject and it is certainly not for everyone. Some religions forbid it, while some people are appalled by its ghoulish nature. If the idea of gifting organs offends you, please skip this section.

Others are comforted by the thought, knowing that their final gift offers the recipient a second chance at life. If you wish to be an organ donor, please sign an organ donor card, have Organ Donor added to your driver’s license or register with your state’s online donation registry.

Even with legal documentation of consent for organ donation, hospitals typically request surrogate consent from family members. The single most important criterion for consent is your family’s knowledge of your wishes for organ donation. At a time when your family is under unimaginable stress, their decision for consent may be complicated by understandable horror and hesitation. Talk to your family and let them know that you are an organ donor.

Learn more and access your state's online donation registry at:

www.organdonor.gov

Not every state has its own organ donation registry, although most do. This site also details how to register on the national level.