The recent environment with Covid brought to light situations where people were faced with needing extraordinary medical care, such as going on a ventilator, well before the age they may have anticipated. It also highlighted how many people, especially younger people, don’t have any sort of estate documents in place!
Estate planning is comprised of many pieces. In addition to documents that govern financial matters, it is important to plan for how medical decisions should be made at the time of your incapacitation. At a minimum, we think that everyone should complete a Health Care Power of Attorney document that appoints a representative (usually a friend or family member) to make medical decisions on their behalf. This document typically also includes directions about the type of care you want to receive when incapacitated. Those who have more specific wishes about the type of care (or lack thereof) that they want to receive toward the end of their life should consider creating additional estate documents.
A living will, more precisely known as a “Declaration of a Desire for a Natural Death” is a type of advance directive regarding your preferences for medical care at the end of your life. A living will is written, legal instruction that layers on top of a Health Care Power of Attorney document. It informs your doctors that if incurably ill, you do not wish to prolong your life by artificial or extraordinary means. It can also spell out when/if you want to use various medical treatments to keep you alive, such as a ventilator or tube feeding.
Having your wishes spelled out can also provide clarity to your loved ones and prevent disagreements among family members at a time they’re forced to make a “life or death” decision.
How do I use one?
Since this is a legal document, it can be helpful to have an estate attorney prepare. However, your state may have standard forms or other options available free of cost.
A living will applies in a hospital or care facility. Plan to share your document with your doctor and healthcare agents. It can also be helpful to discuss your wishes with your loved ones, so they are prepared when the time comes.
The scope of a living will is narrow – it applies only to end-of-life decisions. It also likely doesn’t anticipate every scenario (example: young and otherwise healthy individuals requiring ventilators while recovering from Covid). For that reason, don’t feel you must wait until a terminal illness to create – plan for unexpected events and illnesses, and also plan to update as circumstances and feelings change.
Is there anything else I should consider?
A “DNR” (Do Not Resuscitate Order) has a narrower focus – it directs people not to start life-saving efforts if the event arises; specifically, CPR, which is the treatment you receive when your blood flow or breathing stops. A DNR applies both inside and outside of a medical facility.
Who is this document appropriate for?
A DNR order is typically appropriate for those near the end of their life or whom have an illness that will not improve. These patients may feel that any resuscitation efforts are simply prolonging the inevitable. For that reason, DNR orders are often a part of hospice planning.
If this applies to you, consider talking to your doctor about expectations for your prognosis and the pros and cons of CPR. It can also be helpful to discuss your thoughts with your family and loved ones.
How do I create?
If you determine you do not want to receive CPR, talk to your doctor about a DNR order. Your doctor will write the DNR order in your medical record and can assist you in gathering the applicable documents to keep in your home and/or on your person. A popular place to display any DNR orders is your fridge – paramedics are typically trained to look here when responding to house calls. It is also advisable to carry a copy with you, such as in your wallet.
To ensure your wishes are followed, update your living will, and inform your healthcare agent and family of this decision. Note that your family may not override this decision if your doctor has already written a DNR order at your request.
What if I change my mind?
If you have a DNR order, you always have the right to change your mind and request lifesaving measures. If you do, talk with your doctor and family/caregivers about your decision immediately. You will need to update any documents you prepared that include the DNR order.
The specifications around how to create legally binding documents, including Power of Attorney forms and advance directives, differ by state. We encourage you to work with a team that includes an estate attorney and a financial advisor to review your documents and ensure they are comprehensive and accurately reflect your wishes. And finally – your feelings may change, and with that, your directions about what type of care you’d like to receive at the end of life. Plan to regularly review and communicate any changes to your doctor and caregiver. This planning will ensure you live out your life according to your wishes and provide comfort and reassurance to your loved ones.
Important disclosure information
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