Our Living Wills Practice
Do you remember the Terri Schiavo case that dominated the US news for months? Terry’s parents went to court against her husband arguing over whether Terri’s life support should be turned off. After all of the publicity, legal fees and court time the case boiled down to just one issue, what were Terry’s wishes? The entire case could have been avoided if Terri had written out her terminal care wishes before she got sick. How do you avoid putting your family through what Terri’s family went through? Two simple documents is all it takes, a Health Care Power of Attorney and a Living Will.
What is a Health Care Power of Attorney a/k/a Health Care Proxy?
A health care power of attorney (health care proxy) allows you to appoint someone (your health care agent) to oversee your health care wishes and make any necessary medical decisions for you when you are unable to make them yourself. As long as you are able to understand and communicate your own wishes, your agent cannot override what you want. Your agent steps in only if you can no longer manage on your own. You can give your health care agent as much or as little power as feels comfortable to you. Most people give their health care agent comprehensive power to supervise their care. You can also give your agent the authority to oversee the wishes you’ve set out in your living will. Sometimes the living will and durable power of attorney are combined into a single document, most often called an “advance health care directive.” Unless you specifically place limits on your agent’s authority in the document most health care powers of attorney give the agent the following powers:
- consent or refuse consent to any medical treatment that affects your physical or mental health (there are usually exceptions to this rule for situations such as extreme psychiatric treatments and termination of pregnancy, and your agent is not permitted to authorize any act that violates the wishes you’ve stated in your living will)
- hire or fire medical personnel
- make decisions about the best medical facilities for you
- visit you in the hospital or other facility even when other visiting is restricted
- gain access to medical records and other personal information, and
- get court authorization, if required to obtain or withhold medical treatment, if for any reason a hospital or doctor does not honor your living will or the authority of your health care agent.
Most health care powers of attorney are durable meaning that the agent’s powers survive your incompetency. In addition most health care powers of attorney are drafted so that the agent’s powers do not take effect until a doctor has declared you unable to handle your medical decisions.
What is a Living Will?
A living will (health care declaration) is the place to write out what you do and do not want in terms of medical care if you are unable to speak for yourself. You can pick and chose what you do want and what you don’t want. Some things to consider including in your living will:
Do you want Life-Prolonging Medical Care?
If you are terminally ill or permanently comatose do you want life-prolonging medical care? If yes, which procedures are acceptable and which ones aren’t?
- transfusions of blood and blood products
- cardiopulmonary resuscitation (CPR)
- diagnostic tests
- administration of drugs
- use of a respirator, and
Do you want artificial feeding and hydration?
If you are close to death from a serious illness or are permanently comatose you may not be able to survive without the administration of food and water. Unless you indicate that treatment should be withheld, doctors will use intravenous (IV) feeding or tubes to provide you with a mix of nutrients and fluids. IV feeding, where fluids are introduced through a vein in an arm or a leg, is a short-term procedure. Tube feeding, however, can be carried on indefinitely. Permanently unconscious patients can sometimes live for years with artificial feeding and hydration without regaining consciousness. If food and water are removed, death will occur in a relatively short time due to dehydration, rather than starvation. Such a course of action generally includes a plan of medication to keep the patient comfortable. This decision is difficult for many people. Keep in mind that as long as you are able to communicate your wishes, by whatever means, you will not be denied food and water if you want it.
If you are terminally ill, do you want palliative care?
If you want death to occur without life-prolonging intervention it does not mean you must forgo treatment to alleviate pain or keep you comfortable. Rather than focusing on a cure or prolonging life, palliative care emphasizes quality of life and dignity by helping a patient remain comfortable and free from pain until life ends naturally. Palliative care may be administered at home, in a hospice facility, or at a hospital.
Organ Donation, Cremation, Burial?
If you want to donate your organs, it is good idea to include organ donation in your living will so that your agent and family members are aware of your wishes. In addition since your will may not be reviewed until after your funeral, it is a good idea to include whether or not you prefer to be buried or cremated in your living will which will most likely be reviewed prior to your death.