Advance directives address exactly everything we don’t want to think about. They plan for the worst situations possible, where you are alive yet unable to communicate your wishes for treatment or life-prolonging measures. They ensure that your wishes are communicated, but oftentimes people don’t have them in place when they need them. Read on to learn more about advance directives, how they help, and why you should have one in place.
What is an advance directive?
An advance directive is a document that details what type of health care you do or do not want in the event you are unable to make your own decisions. Studies have shown that while 80 percent of Americans would rather die in the comfort and care of their own homes, 60 percent die in acute care hospitals, 20 percent in nursing homes, and only 20 percent at home. With the advances in medical technology, many people who might have died at home 100 years ago are now kept alive and might end their lives hooked up to machines in a hospital. For many people, this is not the ending they want, but if that is not communicated health care professionals will do what they can to prolong life through medical means. Many people see death as being prolonged through these technologies, making it painful, expensive, and emotionally trying for family and loved ones. Seeing a loved one in a permanent vegetative state can lead family members to question whether the individual would have wanted to be kept alive only to be unable to communicate. An advance directive works to solve these predicaments by providing clear instructions as to what an individual will want in the event they are incapacitated and cannot speak for themselves. There are two main types of advance directives: a living will and a health care power of attorney.
Living Will
The oldest form of the advance directive is the living will, and it was first proposed in 1969 as a way for individuals to document their health care desires in the event they are incapacitated. A living will deals primarily with deathbed concerns. You can outline what types of treatment you wish to receive if you at the end of life, and this document goes into effect when you are no longer able to communicate. Your health care team are required to follow the directives that are outlined in a living will, and your physician will decide when you are unable to make your own medical decisions, and are not expected to regain that ability. A living will could address:
- Resuscitation: If your heart stops beating do you want either CPR or electric shock to restart your heart?
- Mechanical Ventilation: If you have stopped breathing do you want to be hooked up to a machine that breathes for you? And if so, for how long?
- Feeding Tube: Do you want to be fed through a tube that supplies nutrients and fluids if you are unable to eat? And if so, for how long?
- Dialysis: Do you want your blood filtered through a machine if your body is unable to do this? And if so, for how long?
- Antibiotics: If you are unresponsive, do you want medication to be used to treat infection?
- Comfort Care: Outlines the palliative care you will want to keep you comfortable and pain-free if you are unable to speak for yourself.
- Organ Donation: Outlines whether you want to donate organs or tissues and specifies if you will allow to be kept on life-sustaining devices while organs are harvested.
Getting specific in your living will avoids confusion later on. It also helps your family members make difficult decisions about your treatment.
Health Care Power of Attorney
A Health Care Power of Attorney (HCPA) is for all health care decisions, not just end-of-life ones, and will only last while you are unable to make decisions for yourself. An HCPA can also be used to access medical records, and to admit you to a facility to receive care. An HCPA specifies an agent who will carry out your wishes for you, and can be as detailed as you want it to be. Both a living will and a HCPA can be revised or revoked at any time as long as you are mentally competent and able to do so.
Utah Advance Health Care Directive
Utah has created a document that combines the HCPA with a living will in an attempt to make one document that addresses all of the important legal implications of both and to protect against practitioners who refuse to follow the wishes that are outlined.
How do you make an advance directive?
In Utah, your directive can be oral or written, but to make it legal it must be witnessed by someone who does not have personal interest in the matter. This means someone who cannot benefit from your death, to ensure that you are not being coerced or influenced to complete the directive. If you are not able to sign your own directive you can have someone else sign it in your presence. Your witness cannot be:
- The person who signed the directive
- A person related to you by blood or marriage
- A person entitled to any portion of your estate
- A beneficiary of your life insurance policy, trust, or any other plans or deeds
- A person who could benefit financially from your death
- A person who has an interest in or right to your property after death
- A person who is financially responsible for your medical care
- A health care provider who is providing care or administering care in a facility in which you receive care
- Your appointed agent or alternate agent
An advance directive should be stored somewhere that your loved ones are aware of, and not locked away in a safety deposit box. In the event of a tragic event, they will know where to easily access your documents.
How does an advance directive help?
When you leave your family and loved ones without any idea as to your medical wishes, it can leave them in a state of confusion, doubt, and guilt. They may feel unsure as to what you would want done, or they may think that you would prefer not to be kept alive by a machine but feel too guilty to try to advocate for that (and they probably won’t be able to if there is no documentation). Think of your family spending years caring for you in a vegetative state—and consider what directives you could do to avoid that situation. An advance directive can bring peace of mind to the individual writing it, knowing that they will not burden their families and friends with difficult decisions if they become physically incapacitated. An advance directive also helps family members have the confidence and peace that they are going along with their loved one’s wishes.
Who needs an advance directive?
Really, everyone. You must be at least 18 years old to create an HCPA, living will, or advance directive, and you must be of sound mind. No one can coerce you into creating a document outlining your wishes. If you are over 18, having an advance directive in place that you revise over time ensures that if any unforeseen tragedies occur your family will know exactly what your thoughts were regarding your end of life care or life-prolonging measures. Many people are reluctant to create these types of documents because the subject matter makes them uncomfortable, but think of the consequences of having no documentation in place.
As you get older, the reality of these situations becomes more pressing, but tragedy can strike at any time. Counseling with an elder attorney at The ElderCare Law Firm can help bring clarity to your health care planning, help you know what documents you need, and get the expertise of someone skilled in senior legal issues. Don’t neglect to create an advance directive! Doing so as soon as possible will bring peace to you and your family—schedule an appointment with The ElderCare Law Firm today!