Two Documents You Should Have for End-of-Life Planning

Talking about the type of care we want in our final days is something our culture tends to avoid, but a growing number of people believe that the value of such conversations far outweighs the discomfort.

As important as it is to talk about our end-of-life wishes, it’s just as important to create a legal record of those wishes. To ensure that your wishes are carried out, especially if you become physically or mentally incapacitated and unable to express those wishes, experts from both the health care and legal professions recommend you have two important documents in place:

• A living will
• A durable power of attorney for health care

Retaining an attorney to create these documents is recommended to be sure they are prepared correctly to meet the requirements of your state. However, it is not always necessary, or legally required, to have an attorney create these documents. Numerous organizations offer templates of both of these documents, including CaringInfo (a program of the National Hospice and Palliative Care Organization) and Aging with Dignity’s Five Wishes program. Five Wishes has documents available in 29 languages and meets the legal requirements in 44 states, and is widely used in the other six states with the completion of one additional step. If you use an online template, make sure that it’s specific to the state you live in, since requirements vary from state to state.

Here’s some information on what each document is for and why they’re so important.

Living will

A living will, also known as an advance health care directive, is a legal document in which you give instructions regarding your preferences for medical care in the event you are unable to make decisions for yourself. Living wills provide guidance for doctors and caregivers in instances such as terminal illness, coma, late-stage dementia or end-of-life care.

Why you should have it: By planning ahead, you can get the medical care you want and avoid care you don’t want. A living will can relieve your loved ones and caregivers of having to make what could be agonizing decisions. It can also help minimize confusion or disagreement about the choices you would want people to make on your behalf.

A living will forces you to answer difficult questions about end-of-life care. You may want to consult your doctor about what to include in your living will. Medical situations and procedures that can be addressed in a living will include the following:

• Instructions on tissue or organ donations
• CPR or shock equipment used if you go into cardiac arrest
• Mechanical ventilation if you’re unable to breathe on your own
• Tube feeding to provide nutrients and fluids intravenously or via a tube in the stomach
• Dialysis to remove waste from your blood and manage fluid levels if your kidneys no longer function
• Antibiotics or antiviral medications to treat infections (your living will can make clear whether or not, if you are near the end of life, you want infections to be treated or left to run their course).
• Palliative care, which is slightly different from hospice and includes interventions that may be used to keep you comfortable and manage pain while abiding by your other treatment wishes.

When your living will is complete, you should give a copy to your doctor’s office and to the person you’ve assigned durable power of attorney for health care. Keep the original in a safe place at home — but not so safe that no one can find it.

Durable power of attorney for health care

This is a type of advance directive in which you name a person to make decisions for you when you are unable to do so. This person may be referred to as a health care proxy.*

Why you should have it: If you are physically or mentally unable to tell doctors about your medical wishes, the person you have assigned durable power of attorney will do so for you. This situation typically occurs because you are either unconscious or mentally incapacitated to a degree that you lack the legal capacity to make your own decisions.

When assigning durable power of attorney for health care, you should choose a person you trust to make decisions that follow your wishes as indicated in your living will. The person may be a spouse, family member or friend, but cannot be your doctor or part of your medical care team.

It’s critically important that the person you choose to handle this role agrees to it. What you’re asking them to (potentially) do could be extremely stressful, and it would be unfair to put anyone in that position without their consent.

Preparing a living will and assigning durable power of attorney for health care involve decisions that can be uncomfortable and difficult. But by creating these documents, you not only give yourself comfort that your end-of-life care will be in accordance with your wishes and values, but you may very well be removing a huge emotional burden from your loved ones.

*Depending on the state where you live, a health care proxy might also be called a health care agent, health care representative or health care surrogate.

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