Advance Directives: Preparing for the Tough Decisions

For the most part, having different perspectives and points of view from our closest family and friends can be a good thing. But imagine a situation in which the different values of those we love have more serious consequences – consequences that may determine how we live the last moments of our lives.   Situations like these are all too common in hospitals and intensive care units throughout the country, when family members are left blindly guessing what steps to take in the care of an incapacitated loved one. 

Many of these difficult end-of-life situations can be greatly facilitated by the creation of a basic set of care guidelines known as advance directives.  Advance directives, particularly the health care proxy and living will, provide direction to health care professionals; a sense of peace to family and friends; and dignity for those of us unable to make our own decisions.  In addition to addressing healthcare and legal areas, some living wills provide opportunities for us to leave instructions that speak to our more personal and spiritual wishes – music we’d like to have played, favorite passages or prayers we’d like to have said, pictures of loved ones close by and, perhaps, a life testimony to be read.  It is a way of saying in advance, “Thank you for the kind and attentive way you are caring for me.  Please remember the wonderful times we had together along the journey.”

Health Care Proxy

A Health Care Proxy form designates a representative or agent,  who can make  medical decisions on your behalf.  This health care agent will in effect assume control the way in which you live or die – so it is every important to designate someone you trust! Remember, this person will not assume control over your medical care until a physician has determined, in writing, that you are unable to make your own decisions.   Until then, you will retain total control. 

 It is important to leave your health care agent with a detailed sense of what you want.  One study found that 74% of health care proxies did not make the right decision for their charges because they lacked adequate information about the patient’s wishes.  One effective way to leave your health care agent with a sense of your wishes is to establish a living will.

Living Will

Some living wills provide only general instruction, while others go into great detail about the wishes of patients.  The basic idea of a living will is to provide guidelines for how you wish to be treated if you are ever incapacitated.   A Living Will can help make the most difficult decisions – such as whether to end or prolong curative treatments or life support – plain and clear. 

Because living wills differ in their scope and are often confined to the strictly medical aspects of health care, they are executed with varying levels of effectiveness.  Countless medical complications may arise and it is impossible to imagine all of them, let alone leave guidelines for others acting on your behalf.  With this difficulty in mind, the Florida-based advocacy group Aging With Dignity created what has become one of the most popular living wills in the world: the Five Wishes Program.  Translated into 26 different languages, Five Wishes deals holistically with the individual, taking not just medical but also spiritual and personal concerns into account.  For this reason it has been called the “most human living will.” 

The document goes into great detail and allows you to make your wishes known.  It is also convenient because it designates a health care proxy as its first wish.  Rather than having two separate forms – a living will and a health care proxy – the Five Wishes document keeps everything together in one convenient place. 

Durable Power of Attorney

Think of this as the financial version of your health care agent.  The person to whom you grant power of attorney will have the right to make financial decisions on your behalf once you become unable to do so yourself.  This person will be authorized to make banking transactions, endorse and write checks to pay for basic expenses like utilities, or apply for disability. The word “Durable” means that whoever has power of attorney will retain that power after you become medically incapacitated.   

Getting Started

To request a Health Proxy Form, inquire with your Health Care Provider, or contact Massachusetts Health Decisions, PO Box 417, Sharon, MA 02067.  They will send you a brochure, a six-page User’s Guide and two copies of the form for $6 postpaid. 

To order a copy of the Five Wishes document, call (888) 5 WISHES (888-594-7437) or visit online at http://www.agingwithdignity.org/five-wishes.php

Another popular and detailed living will, virtually identical to the Five Wishes, is Caring Conversations.  For more information, you call the Center for Practical Bioethics at 816 221-1100, or download the document online at http://www.practicalbioethics.org/FileUploads/FINAL.Caring%20Conversations%20Workbook%202010.pdf.

You can obtain forms for durable power of attorney from your bank or financial institution.  Massachusetts law requires that a notary public be present when you sign the these forms, but no witnesses are required.