Getting Your Affairs in Order

What you need to know—and share—about end-of-life choices

For many people, end-of-life choices are a subject to be avoided. The unfortunate outcome of that avoidance is often a difficult and painful scramble for family members when someone unexpectedly takes seriously ill. But in the case of the 1/3 of Americans who have been proactive in creating advance directives prior to falling ill, navigating those decisions is greatly simplified; providing comfort and direction for all.

Simply put, advance directives are legal documents that let you spell out what you do and don’t want in terms of medical treatment and care should you lose the capacity to speak for yourself. These documents can be extremely helpful to family, friends and even healthcare professionals in the moment of crisis. Relatively easy to draw up (see box), they can minimize confusion about choices and provide comfort to those around you.

The two most common advance directives for healthcare are the living will and the durable power of attorney. Here’s what each is specifically designed to do:

A living will outlines which treatments you want if you are dying or permanently unconscious. You can choose to accept or refuse specific types of medical care including:

• The use of breathing machines or feeding tubes
• If you want to be resuscitated if you stop breathing or your heart stops 
• If you wish to be an organ and/or tissue donor
• Any wishes related to your funeral

NOTE: It’s important to note that the rules for living wills vary depending on where you live. Every state has a slightly different procedure for living wills and different requirements about their creation and execution. While your living will should be based on the rules of the state where you live, if you spend a lot of time in more than one state, you’ll want to verify that it is valid in your home-away-from-home state (we’re talking to you, Snowbirds). 

A durable power of attorney for healthcare is a document that specifies your healthcare proxy, that is, someone you trust to make health decisions for you if you are unable to. This individual must be over 18 years of age, and can not be your doctor or other healthcare provider.

Within the document, you can outline your wishes about your healthcare, including what you do or don’t want. If you have no specific wishes, the document grants your proxy the ability to make decisions on your behalf. These might include:

• Whether to admit or discharge you from a hospital or nursing home
• Which treatments or medicines you do or do not want to receive
• Who has access to your medical records

Only your healthcare proxy can make these decisions, and only if you are not able to do so. Any wishes outlined in your durable power of attorney must be followed.

Once you’ve created both documents, there’s one last critical step: sharing your choices with others. While you don’t need to review every detail and motivating factor, you do need to let your family, friends, and medical providers aware that these documents exist and make sure they know where to find or access them if the need arises.

Pam Duchene, PhD, APRN-BC is the Vice President of Patient Care Services and Chief Nursing Officer at Southwestern Vermont Health Care.