Text Resize
Print
Email
Subsribe to RSS Feed
Tuesday September 21, 2021

Personal Planner

Living Wills and Advance Directives

Living Wills and Advance Directives

As you approach end-of-life decisions, there are several steps that should be taken to make sure you receive the right type and level of care. To assist you in these decisions, most states now permit either an advance directive or a living will. Some seriously-ill persons also have a doctor sign a Physician Order for Life-Sustaining Treatment (POLST). These documents are designed to assist your family and doctors in making the decisions according to your preferences.

Senior Medical Planning


There are three important background areas that you should learn about before entering into senior medical care. These are the medical oath and principles of your care providers, the rules created by Congress to ensure your medical information is protected and the decisions by your state on the specific document that you use to convey your wishes.

Doctors will frequently follow a set of principles that were originally called the Hippocratic Oath. The first oath was written by Hippocrates, a Greek doctor who is considered the father of modern medicine.

A modern version of the Hippocratic Oath typically states, "To practice and prescribe to the best of my ability for the good of my patients." Following this principle, your doctor will attempt to restore you to good health.

Because of modern improvements in medicine, it is possible to prolong your life through the use of ventilators, intravenous feeding and other devices. While you certainly want your doctors and nurses to provide very good care, you may also need to offer some guidance on how extensively your family and doctors should use modern technology to prolong your life.

A second major area for you to understand is called HIPAA. The Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996. It is designed to provide protection for you and to keep your health information private.

Under the HIPAA rules, you have the right to see your health records, but you must give written permission before your records are released to other individuals. The information provided by doctors or nurses about your care, medications or other personal information is protected. However, you will want to be certain that your designated healthcare proxy (the person who will assist in making healthcare decisions) has the right to review these records. You should sign a HIPAA release form in order to enable your advisors to give proper recommendations to your doctors and nurses.

Finally, you must understand the specific documents of your state. Some states use an advance directive in which you choose a combination of a durable power of attorney for healthcare and a living will. Other states have separate documents. It is very important that you use the appropriate document tailored for the laws of your state.

The Advance Directive


Your first key advisor is the person who will make your medical decisions if you are incapacitated. This individual is frequently called the healthcare proxy. He or she is your agent and holds your durable power of attorney for healthcare. Normally, you will select primary and secondary persons as your healthcare proxy agent.

You will want to list the persons, their addresses and phone numbers so they can be easily contacted. Your secondary healthcare proxy will assume the primary role if the first person is unable or unwilling to serve.

Part of your advance directive will also explain the level of authority that you have given. Your healthcare proxy usually does not have the authority to make decisions unless, in the view of your doctor, you are no longer able to make decisions yourself. However, many forms allow you to sign and empower that person immediately. The authority of your healthcare proxy may also extend after you pass away so that he or she can make appropriate decisions at that time.

Your healthcare proxy may be called upon to make significant decisions for your care. For example, it may be necessary to decide whether or not to use morphine or other types of pain medication. If the decision is to make use of morphine, then a second decision will be made on the use of a low dose or a high dose. With a lower dose of morphine or other types of pain medication, you may have greater clarity of mind but may be less comfortable. If you receive higher doses of medication, you may not be as clear-headed, even though you are at a higher comfort level. These decisions can only be made based on your condition at a given time, but they do directly impact the quality of your life in that circumstance.

A healthcare proxy may also be called upon to make very significant decisions about the hospital, nursing home or other care facility and the level of treatment. For example, some seniors have suffered broken hips or limbs at a time when their demise was near. A healthcare proxy will need to make decisions about the appropriate level of care or treatment under those circumstances.

A second section of an advance directive allows you to give counsel on the level of measures and technology that will be used to prolong your life. If you have an incurable or irreversible condition that will result in your death within a relatively short time, there are medical devices that can significantly prolong your life.

These are sometimes referred to as "heroic measures." If you desire all reasonable measures to be taken, you can generally request that care. If you do so, your life may be extended to the greatest extent possible under "generally accepted healthcare standards."

Your healthcare guidelines expressed in your advance directive will discuss your preferred level of nutrition and hydration. If you prefer to receive nutrition and hydration through intravenous methods, you may specifically request those options.

It is helpful for medical providers to have some level of direction for your pain management. If you prefer a higher level of pain management even though that gives you less clarity of thought, you may so indicate.

A third, fairly typical section of the advance directive covers donation of organs and designation of your primary doctor. If you would like to donate specific organs or designate specific purposes for the use of your body, you may identify the particular organs or discuss purposes. Common purposes include transplantation, therapy, research and education.

Advance directives and living wills may, under state law, be witnessed in a manner similar to the witnessing of your will. Some states require two witnesses or a notary to witness your advance directive. Check with your state law to make certain that you have complied with those requirements. A helpful website with state law requirements is caringinfo.org. It is maintained by the National Hospice and Palliative Care Organization and seeks to improve care at the end of life.

Physician Orders for Life-Sustaining Treatment (POLST)


A Physician Order for Life-Sustaining Treatment (POLST) is a medical order signed by your doctor or a medical staff person as authorized under your state law. While the name and provisions may be different in some states, the POLST option is generally available nationwide. If you have a serious illness or may pass away within one year, you may want to ask your doctor to sign this medical order.

The POLST typically covers cardiopulmonary resuscitation (CPR), medical interventions and nutrition. You may choose to have CPR or select "Do Not Resuscitate (DNR)." Your medical interventions may include full treatment to prolong your life, selective treatment that avoids burdensome procedures or comfort-focused treatment. Nutrition can be maintained long-term with feeding tubes, for a trial period or you may select no artificial means of nutrition.

All of these decisions should be made in consultation with your doctor. Both your doctor and you or your healthcare proxy must sign the POLST. Your POLST may reflect your values, religious beliefs and goals for care.

Even if you have a POLST signed by your healthcare provider, you still need an advance directive. The advance directive appoints your healthcare proxy (primary and secondary) and covers many medical circumstances not covered by the POLST. Everyone should sign an advance directive, while those who are seriously ill may benefit from a POLST.

Action Steps


After completing your living will or advance directive, you will sign and typically have witnesses for your original document. Prepare several copies of your advance directive. You will want to give a copy to your healthcare agent, your family, clergy, your doctors and other advisors who may be involved in assisting with your medical decisions.

At any time you may revoke the living will or advance directive. It generally is best to revoke the entire document and complete a new document. If you attempt to amend different parts of the advance directive, there is a risk that you may sign provisions that conflict or are inconsistent. If you are in need of urgent care or treatment, you do not want any conflicting provisions in your living will or advance directive.

Your living will or advance directive is a very important part of your personal planning. It is designed to help you receive the best possible care at the end of your life and still comply to the greatest extent with your personal healthcare preferences.

Published July 23, 2021

Print
Email
Subsribe to RSS Feed

Previous Articles

Your Family Letter - Memorial Services

Integrity and Initiative

Helping Children Tomorrow

Helping Children Today

Do You Have a Difficult Family?

scriptsknown
  • Bequests
    Bequests
    Joe and Anna have been faithful supporters of our organization. They believe it is important to help further our mission.
    More
  • Using a Beneficiary Designation to Make a Gift to Charity
    Using a Beneficiary Designation to Make a Gift to Charity
    Joanne and her late husband Hal had been longtime supporters of our organization. Recently, Joanne's children encouraged...
    More
  • Fixed Income for Retirement
    Fixed Income for Retirement
    After working for decades as a pediatrician in a small town, Patricia is ready to retire.
    More
  • Tax-Free Sale
    Tax-Free Sale
    Howard and Lynn were both age 55 when they purchased some vacant land a few miles outside of town. They thought real estate would be a good investment that could be sold later for a profit.
    More
  • Capital Gains Tax Bypassed
    Capital Gains Tax Bypassed
    Peter and Gail were nearing retirement. Over the years, with the help of their financial advisor, they made solid investments in securities and built a sizable portfolio.
    More
  • Peace of Mind Gift Annuity
    Peace of Mind Gift Annuity
    Many years ago, Clara bought a home. Since she was very pleased with her home, she bought stock in the company that built the home.
    More
  • Endowment Gift
    Endowment Gift
    Pat and Shelly were recently married. They both had been dedicated volunteers at their favorite charity for many years.
    More
  • Sale and Unitrust
    Sale and Unitrust
    Gene and Carol purchased stock in a small medical service company several years ago. The company has done well.
    More
  • The Retirement Unitrust
    The Retirement Unitrust
    Mary grew up on a farm. When her parents passed away, she and her husband Bill inherited the farm.
    More
  • Property Turns Into Income
    Property Turns Into Income
    Miranda lived in the family home where she and her spouse had raised their three children. After her spouse passed away, Miranda found it increasingly difficult to care for her property.
    More
  • Flexible Deferred Gift Annuity
    Flexible Deferred Gift Annuity
    Luis is a 54-year-old executive at a large healthcare company. He purchased company stock during years when the stock price was low, and now the stock has grown substantially in value.
    More
  • Part Gift and Part Sale
    Part Gift and Part Sale
    Susan and Kevin bought a vacant lot along Lake Michigan many years ago. They had planned to build a second home so that their family could spend their summers along the lake.
    More
  • Current Gifts
    Current Gifts
    As is the case with many families, there are times each year when Jim and Sharon focus their attention on gift giving.
    More
  • Gift of a Bank Account When No Longer Needed (POD)
    Gift of a Bank Account When No Longer Needed (POD)
    Keith has been a faithful supporter of The Marfan Foundation and makes regular gifts to support our work.
    More
  • Transferable on Death (TOD) Gifts
    Transferable on Death (TOD) Gifts
    Harold and Jeanne married after meeting at an event The Marfan Foundation held for our donors. They wanted to leave a legacy gift...
    More
  • A Bequest to Further Good Work
    A Bequest to Further Good Work
    Nancy and David were dedicated volunteers. Over the years, they had seen many individuals helped by the good work of their favorite charity.
    More
  • Deferred Gift Annuity
    Deferred Gift Annuity
    Several years ago, Larry and Allison invested $30,000 in what they believed to be an attractive stock.
    More
  • What Will You Do with Your Unspent Retirement Savings?
    What Will You Do with Your Unspent Retirement Savings?
    Michael and Kelly were retired engineers with two adult children. They owned a home, some stocks, and IRAs.
    More
  • Gift Annuity for Real Estate
    Gift Annuity for Real Estate
    Jonathan purchased his home many years ago for $80,000. The home is now worth $420,000. Jonathan wants to sell his home and buy a condo for $130,000.
    More
  • A Bequest to Save Taxes
    A Bequest to Save Taxes
    Thomas was a widower who had a great love for our organization. As an individual who had directly benefited from our work, Thomas wanted to thank us with a gift from his estate.
    More
  • Leading for the Future
    Leading for the Future
    Luke and Cynthia spent many years volunteering and supporting their favorite charity. They wanted to give back in a way that would help fulfill its mission.
    More
  • Give it Twice Trust
    Give it Twice Trust
    While visiting her favorite charity's website, June came across the idea of a give it twice trust. She contacted the charity for more information.
    More
  • Providing for Our Children's Future
    Providing for Our Children's Future
    Ron and Kathy worked for many years building their nest egg for retirement.
    More
  • Bequest of Insurance
    Bequest of Insurance
    Marla and Wayne purchased a life insurance policy many years ago to create security for their children's future.
    More
  • Testamentary Charitable Remainder Unitrust: Have Your Cake and Eat it Too!
    Testamentary Charitable Remainder Unitrust: Have Your Cake and Eat it Too!
    We have all heard the saying "You can't have your cake and eat it too." This phrase describes a situation where we want two good things at the same time when that isn't possible.
    More
  • A Personal Donor Story
    A Personal Donor Story
    "I want the work of the foundation to go forward whether I'm here or not"
    Estate planning is your final statement about the causes you care about
    More