Healthcare as YOU Wish
Healthcare as YOU Wish! While we typically associate estate plans with all the things that happen after death, they should also include instructions about how to handle your health care when you appear to be close to death or in an unresponsive state. It’s important to consider your end-of-life health care for multiple reasons.
Having documentation about what you want for your body gives you control. Everyone has different levels of pain tolerance, standards of living, and willingness to be vulnerable.
Are you open to more pain if it means being conscious and having a chance to say goodbye to your family before you die? If you’re in an accident and fall into a coma, how long do you want doctors to keep you alive? Would it make a difference if you’ll be paralyzed from the neck down for the rest of your life? Are you willing to have family see you and take care of while in a paralyzed state? How do your answers change if you’re 85 years old and lived a good life or 45 years old with kids still at home? If you have strong feelings about how you’re treated in any of these and other similar scenarios, then you should take the time to make your wishes known.
Who decides how you are treated at the end of your life will impact your surviving family members. If you have documented your wishes and talked to your family about them, then it will be easier for them to cope with how your treatment plays out. If your wishes are not known, surviving family members may argue about your treatment. These types of disagreements often result in resentment and blame that causes family rifts for years following the death of a loved one.
Documenting your wishes and discussing them with important people in your life, including your doctor, eliminates the heavy burden placed on others who make medical decisions on your behalf when you’re incapacitated. Making your desires known takes guessing what you want out of the process. Guessing can lead to tremendous guilt and a lifetime of wondering if they made the right call regarding your health.
Get it in Writing
While it’s important to express your wishes verbally to your family, documenting them in writing is more critical. Legal documents eliminate the need for family to remember what you told them and it helps minimize disagreements between others about what you want for your care.
Multiple types of healthcare documents exist, and like “estate plans” and “wills”, the names are often used interchangeably. Knowing which is which can be confusing. Below are the more common definitions of these various types of documents.
Advanced Directive
An advanced directive isn’t a document. Instead, it is the umbrella term we use to describe your overall healthcare game plan in the event that you become incapacitated and unable to speak for yourself. It may include multiple parts, including a living will, DNR, medical power of attorney, and HIPAA forms.
Living Will – Written instructions about the kind of care you want when you are dying, seriously ill, and/or in a life-threatening medical emergency. A living will often details when you wish CPR to be performed, whether to place you on a ventilator to keep you alive, and whether to provide artificial nutrition through feeding tubes. It may also detail your wishes regarding pain management, comfort care, and organ donations.
While it may seem like a no-brainer to want to be kept alive at all costs, there may be situations when you might think otherwise. For example, what if the prognosis is that you’ll be completely paralyzed, can’t communicate, and/or can’t feed or use the restroom by yourself?
Do Not Resuscitate (DNR) – A DNR specifically tells medical personnel that if you go into cardiac or respiratory arrest that they are not to take life-saving action. It is ordered by the doctor at your request only if you are nearing the end of your life, have a terminal illness, or if you have a chronic disease. Generally, you and the doctor will discuss a DNR’s ramifications before you both sign it and the doctor enters the information into your medical file. You are also given paperwork and/or a necklace or bracelet that instructs medical professionals outside of the hospital of your wishes.
Durable Power of Attorney for Healthcare -- Authorizes a specific healthcare agent (e.g. a family member, friend, doctor, etc.) to make medical decisions on your behalf when you are unable to do so. This may include authorizing or refusing treatment on your behalf.
Typically, this authority is given when you are in a coma or otherwise incapacitated. As long as you are capable of making informed decisions on your own, you maintain the right to make healthcare related choices.
Under the authority of this document, your health care agent has the same rights as you normally would to receive information about your past and present health condition and treatment options. The decisions you allow your designated healthcare agent to make are also spelled out in this document.
The living will and healthcare power of attorney work together. Without your desires in writing, your agent will have to rely on memory to recall your healthcare wishes, if in fact you ever verbalized them to your agent in the first place. And without a healthcare agent, your physical well-being will be decided by strangers.
Finally, remember that the person you’ve trusted to make these healthcare decisions for you will probably be distraught and worried for you when they are called on to act in your behalf. Having your wishes in writing will give them confidence to make choices according to your desires. It also offers backup in the event that other family members or friends push for different treatment options for you.
HIPAA Release Form – Though your healthcare power of attorney should be enough to allow your medical team of doctors and nurses to share information about your condition and care with your agent, having a signed HIPAA release form is a recommended backup. Healthcare institutions and professionals can be so in tune with following HIPAA laws that they may be reluctant to share information without a HIPAA- specific authorization form. When your life is in jeopardy you don’t want your authorized agent and doctors to be haggling over paperwork. Work with your attorney and/or your healthcare providers to make sure you have the appropriate paperwork.
Make it Legal
Check with your state's laws on what it takes for your advanced directive documents to be legal. Most states require either witnesses to sign your documents or notarization for them to be considered valid. Some states require both.
If you have questions about how to complete an advanced directive for your specific situation, we encourage you to speak to an attorney. It's worth the cost to make sure that these documents are correct and say what you want them to say.
ACTION ITEM:
1. If you have not completed an advanced directive, contact your insurance or hospital. They will have templates that you can complete.
2. If you have completed an advanced directive, review it and make any needed changes.
3. Check your state's requirements for witness signatures or notarization and make sure that your documents comply.
