(1.16.25) "Today, we will continue our look at the essential components of a comprehensive estate plan by focusing on advance directives, vital legal documents that empower individuals to articulate their end-of-life preferences in situations where they may be unable to communicate their wishes due to incapacitation," stated professional fiduciary and certified elder law Attorney RJ Connelly III. "Typically, advance directives comprise two key elements: a living will, which outlines specific medical treatments and interventions one may or may not want, and a healthcare power of attorney, which designates a trusted individual to make healthcare decisions on one's behalf. Understanding these documents is crucial for ensuring that personal values and choices regarding medical care are respected during critical times."
These documents also provide legal guidance to doctors and family members, ensuring your healthcare preferences are honored, especially in critical situations like terminal illness or severe injury. Many people mistakenly believe advance directives are only for older adults, but medical emergencies can happen at any age.
Healthcare Power of Attorney
A medical or health care power of attorney is a type of advance directive in which an individual designates a person to make medical decisions on their behalf when they cannot. In some states, this directive may also be referred to as a durable power of attorney for health care or a health care proxy.
Selecting a suitable person to act as one’s healthcare agent is critical. While other legal documents regarding medical care may exist, not all situations can be anticipated, necessitating someone who can make informed judgments regarding one’s preferred care.
When selecting a health care agent, it is essential to consider an individual who meets the state’s criteria for such a role, is not affiliated with one’s medical care team, possesses the willingness and capacity to engage in discussions about medical treatment and end-of-life matters, can be trusted to honor one’s values and wishes in decision-making, and can advocate effectively in the event of disagreements concerning care.
The chosen individual may be a spouse, other family member, friend, or a faith community member. Additionally, one may wish to appoint one or more alternative agents if the primary agent cannot fulfill their responsibilities.
The Living Will
A living will is a formal and legally binding document articulating the medical treatments an individual consents to or declines to sustain life. It also outlines preferences regarding additional medical decisions, including pain management and organ donation.
When contemplating your wishes, reflecting on your core values is essential. Consider the significance of independence and self-sufficiency in your life and identify the circumstances under which you may perceive your existence as lacking value. Would you desire medical treatment to prolong your life in all scenarios? Only in specific situations? Would you prefer treatment exclusively if a cure is attainable?
It is advisable to address a variety of potential end-of-life care choices within your living will. If you have inquiries concerning any of the medical decisions listed below, please consult your healthcare provider for clarification.
Cardiopulmonary resuscitation (CPR) - Determining if and when you would want to be resuscitated by CPR or a device that delivers an electric shock to restart the heart after it has stopped beating.
Mechanical ventilation - A mechanical ventilator is a machine that helps you breathe if you cannot do so by yourself. It’s important to think about whether, when, and for how long you would want to use a ventilator if needed.
Tube feeding - Nutritional support can be provided to the body through intravenous methods or by using a tube directly inserted into the stomach. It's important to consider your preferences regarding the initiation, duration, and conditions under which you would want to receive nourishment in this way.
Dialysis - Dialysis is a medical treatment that removes waste products from your blood and helps regulate fluid levels when your kidneys are not functioning properly. It is important to consider the timing and duration of this treatment based on your individual health needs and preferences.
Antibiotics or antiviral medications - Antibiotics can help fight different types of infections. If you were in a situation where time was running out, would you prefer to have infections treated very actively, or would you let them take their natural course?
Comfort care (palliative care) - This involves numerous ways to help you feel comfortable and manage pain while respecting your wishes for treatment. This could mean staying home during your final moments, receiving medicine to ease pain, being given ice chips to help with a dry mouth, and choosing not to undergo stressful tests or procedures.
Organ and tissue donations - You can specify your wishes regarding organ transplantation in your living will. If your organs are selected for donation, it is important to understand that you will remain on life-sustaining treatment for a short period to facilitate the donation process. You may wish to include a statement in your living will acknowledging your awareness of this temporary medical intervention to prevent any potential misunderstandings.
Donating your body - For those interested in contributing to scientific research, arranging a planned donation for research purposes is possible. Contact a local medical school, university, or donation program. They can provide detailed information on the registration process and how your donation can support important studies.
DNR and DNI
It's important to know that having an advance directive or living will is not required to establish Do Not Resuscitate (DNR) and Do Not Intubate (DNI) orders. These orders reflect your healthcare preferences and should be discussed clearly with your physician, who will document your wishes in your medical record. Even if you have a living will, it’s advisable to establish formal DNR and DNI orders each time you are admitted to a new hospital or healthcare facility, as policies may vary. This reinforces your wishes and helps prevent misunderstandings, ensuring your treatment plan prioritizes your preferences.
The POLST/MOLST
A Physician's Order for Life-Sustaining Treatment (POLST), also called in some states a Medical Order for Life-Sustaining Treatment (MOLST), is an important document for individuals with serious illnesses to communicate their treatment preferences. Think of it as a prescription outlining desired medical care in emergencies, completed by a doctor based on your discussions and wishes.
The POLST/MOLST stays with you, typically near your bed in a hospital or nursing home, and should be visible at home or in hospice care for responders. While specifics can vary by state, it generally indicates treatments you want or do not want, including resuscitation, breathing machines, tube feeding, and antibiotics, as well as preferences about hospital transport and pain management.
It also includes information about any advance directives and your health care agent. You can update or cancel a POLST/MOLST at any time.
Updating Advance Directives
You can change your advance directives anytime, which can be important as your healthcare preferences evolve. The process involves a few key steps if you decide to make changes. First, you must create a new form that outlines your updated wishes. Once you have completed the new directive, you must distribute new copies to relevant parties, such as your healthcare provider and designated healthcare agent. After ensuring that the new directives are in place, you must destroy all copies of any previous directives to avoid any confusion.
It’s important to note that the specific requirements for changing advance directives can differ depending on the laws of your state, so be sure to familiarize yourself with those regulations. Discussing any changes with your primary care doctor is also crucial; it can help ensure that the new directive appropriately replaces the old one in your medical file. The new directives must also be updated in any medical charts maintained by hospitals or nursing homes where you might receive care.
In addition to medical professionals, take the time to have open conversations with your healthcare agent, family, and friends about the changes you have made. This ensures that everyone is informed and that your wishes will be respected if they need to be implemented.
It’s a good practice to review your advance directives periodically, especially if you experience significant life changes such as receiving a new medical diagnosis, experiencing a change in marital status, or simply at regular intervals every five to ten years. These updates can help ensure that your directives accurately reflect your current preferences and values regarding medical care.
A Final Note
"Taking the time to create advance directives is a heartfelt and caring choice that ensures your healthcare preferences are respected, even when you cannot communicate them yourself," said Attorney Connelly. "These important legal documents express your wishes regarding medical treatments and interventions, guiding healthcare providers and your loved ones during challenging moments. By preparing these directives, you share your intentions and help ease the emotional burden on your family, allowing them to focus on what truly matters during difficult times."
Please note that the information provided in this blog is not intended to and should not be construed as legal, financial, or medical advice. The content, materials, and information presented in this blog are solely for general informational purposes and may not be the most up-to-date information available regarding legal, financial, or medical matters. This blog may also contain links to other third-party websites that are included for the convenience of the reader or user. Please note that Connelly Law Offices, Ltd. does not necessarily recommend or endorse the contents of such third-party sites. If you have any particular legal matters, financial concerns, or medical issues, we strongly advise you to consult your attorney, professional fiduciary advisor, or medical provider.
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