You’ve completed the Letter of Intent (LOI) for your child, but what about planning for your own care? (You may want to check out our new, downloadable Parent's Guide to the Special Needs Letter of Intent.) Two-thirds of all adults have no living will or other health care directive. Regardless of your age, it is always a good idea to let others know your values, wishes and care preferences should an emergency arise and you are unable to communicate.
An Advanced Care Directive is a legal document in which a person specifies which actions should be taken for their health if they are no longer able to make decisions for themselves due to illness or incapacity. An advanced care directive may go by several names: Living Will, Durable Power of Attorney for Health Care, Medical Power of Attorney or Health Care Proxy.
There are many circumstances to consider and your decisions may change over time, but you may find it helpful to get started by breaking advanced care planning down into 3 steps:
- Learning about and thinking through the types of decisions you will have to make
- Formalizing your decisions in a legal document
- Sharing your decisions with all relevant people, including your appointed health care proxy, your family and friends, legal professionals and your healthcare providers
The types of decisions you will have to make
It is very difficult to think through what your wishes might be given the infinite number of emergency situations which could occur. An important first step is to think about what you value; those things that make life most meaningful for you. Then you can begin to consider the level of medical treatment you would want to receive.
For example: (Source NIH)
- if a stroke leaves you unable to move, would you want CPR? If you became mentally impaired by the same stroke, would your decision change?
- If you are in pain at the end of life, would you want pain medication even if it made you drowsy and non- communicative?
- If you are permanently unconscious and then develop pneumonia- would you want antibiotics and a ventilator?
Regardless of your wishes for aggressive treatment, palliative care, meaning treatment to mitigate pain and keep you comfortable, should always be considered.
In your advanced care directive you can outline the types of medical treatment you would and would not wish to receive. Included should be your thoughts about life support treatment and your goals for all of these treatments including:
- Use of equipment such as dialysis and ventilators,
- DNR or Do Not Resuscitate Orders- meaning you do not want CPR administered
- Fluids via IV and food supplied by tube feeding,
- Use of major surgery, blood transfusions, antibiotics
- Use of Pain medication
In addition, you may specify your wishes regarding organ donation in an advanced care directive.
Who should make care decisions for you?
You should choose a person you know well and whom you feel knows you well. This person should be capable of handling the responsibility that comes with making decisions and advocating on your behalf.
This person, who may be referred to as your medical proxy or health care agent, does not automatically get called in to make decisions unless you are unable or incapable of speaking for yourself. In addition, if you are able to make decisions for yourself in the case of an emergency situation, you are not bound by the contents of your Advanced Care directive- you may decide whatever you wish at that time and you may revoke your advanced care directive at any time.
You should also name a second individual as an alternate health care proxy.
Formalizing Your Decisions in a Legal Document
Some states have specific documents to be completed to achieve your advanced health care directives. Massachusetts does not have a statute governing the use of living wills and there is no “Massachusetts Living Will” document.
You may request an advanced care directive form from your attorney, however there are high quality free/ very inexpensive online resources to formalize your wishes including Caring Info, a program of the National Hospice and Palliative Care Organization and The Five Wishes.
Once you have completed your advanced care directive be sure to sign it under the appropriate circumstances as many states have notice and signature witnessing requirements.
Communicating Your Decisions & Sharing Your Documents
It is critically important to discuss and share your decisions with the people you have appointed as your health care agent and your health care providers. You should also share this document with them. You may change your advanced care directive at any time and if you do, you should destroy all copies of prior directives and share the new directive with the appropriate people.
National Institute on Aging, Advanced Care Planning: Health Care Directives
American Cancer Society, Types of Advance Directives
American Bar Association, Myths and Facts about Health Care Directives
National Hospice and Palliative Care Organization, Massachusetts Advance Directive
Aging with Dignity, The Five Wishes
The information provided here is for general information only and should not be considered an individualized recommendation or personalized investment advice.