Tuesday, Apr 12th 2011

Should You Have a Living Will?

One of the reasons I love writing about health is that it gives me the opportunity to learn about all the various things I've always wondered and been curious about—and then share what I've learned. Like why I can't hear as well as I used to and how to rev up my metabolism. I've been fortunate to cover many other topics of interest—sometimes numerous times, with a different twist—in my three years of writing this blog.

But there is one topic that I've ignored and never once tackled. I try to keep the tone of this blog light and fun. Yet, I think it's time for this serious topic.

It's a topic that makes me uncomfortable and even a bit sad, and I know I'm not alone in this feeling. In fact, the vast majority of Americans—a staggering 70 percent—are so uncomfortable with it that they have ignored it, too. But it's one of those things that is really too important to keep sweeping under the rug.

The topic? Advanced directives, also known as living wills. An advanced directive is a legally binding document that details your end-of-life requests in case you cannot speak for yourself. Imagine you are injured in a car accident and end up in a vegetative state. Or you have a terminal illness. There are myriad decisions that have to be made (what kind of care and/or intervention do you want?) but you are no longer a participant in those decisions, so the burden falls to your closest family member(s). Yet, they have no idea what you would have wanted since you did not have a living will in place. Your wishes might have differed markedly from theirs, but now they are left with the responsibility. Often, it's just guesswork.

A study in the Annals of Internal Medicine in February highlighted the negative emotional effect of that scenario and found that at least one-third of the end-of-life decision makers suffered substantial negative emotional effects, lasting well beyond the actual event. There are a few emotions I can think of—among them guilt, doubt, stress and worry. If you've already been through it with a loved one, I'm sure you can add many of your own.

April 16 has been designated as National Healthcare Decisions Day and it's a timely reminder and opportunity for all of us to pay attention and learn. This is a collaborative effort of more than 100 national and over 1,000 state and community organizations to encourage all adults in the United States with decision-making capacity to communicate and document their health care wishes.

The effort has been recognized by corporate America, too. Amedisys, the nation's leading health care and hospice company, educates its 16,000 employees with seminars. It distributes the Five Wishes booklet (a living will) to every one of its employees. I'm grateful for the discussion guide they've supplied to use as a reference while broaching this often difficult subject:

• Discuss Potential Scenarios: Talk with your physician and loved ones about the numerous medical scenarios and procedures you or your loved ones could face. Then, decide on the specific medical treatments you do or do not wish to receive. In addition to an advance directive, you can work with your doctor to sign a Physician Order for Life-Sustaining Treatment (POLST) to make clear what treatments you do and do not want to receive.

• Choose a Medical Power of Attorney: Specify one person who will have the power to make health care decisions for you in the event you cannot make the decisions yourself. This person is often referred to as your "health care agent." You should choose someone who will advocate for your wishes, not their own. Document the identity of your health care agent in writing and discuss with your loved ones. Your advance directive will be this person's guide for making health care decisions for you, should you become unable to make decisions for yourself.

• Decide on a Level of Medical Intervention: In your advance directive, choose a level of medical intervention that you are comfortable with. Some patients simply want pain management; others may seek a moderate level of medical involvement (such as artificial hydration or antibiotics); while others will request that all life-sustaining measures be used (such as CPR and artificial resuscitation).

• Explore the Gift of Hospice: Document whether you'd like to receive hospice care, also known as palliative care. This pain management and end-of-life care provides comfort, dignity and quality of life to those facing a life-limiting illness, as well as support for their loved ones. You can learn more about hospice care at www.amedisys.com.

• Communicate the Location of Documentation: Tell your loved ones about how and where your advance directive can be located in the event of a medical emergency. Some, but not all, states offer databases where an advance directive can be accessed when the patient does not keep a physical copy on him/her. Other states may not have this option, so it is important that you tell your loved ones the location of your advance directive. Note: a POLST will stay with your medical records.

• Talk With Your Medical Provider: After you document your wishes in an advance directive, talk with your health care provider(s) about your wishes. It's important to note that some states legally permit medical staffs to deny care that conflicts with their ethical values, even if that means not delivering the care you want. If this is true in your state, talk to your doctor and an attorney about how your wishes can best be carried out.

• Involve Your Attorney: Meet with your attorney to help you define your wishes in an advance directive and document them appropriately.

• Research State Laws: If you'd like to look at an advance directive that is legally recognized within your state, before talking with an attorney, resources are available at: www.nhdd.org.

Other pertinent reading:
Basic Legal Healthcare Tools
Start Talking About Life's End Well in Advance

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