In a recent blog post, "Dollars & Health: Living wills, death panels and my dad," Andy Miller advocates for use of "living wills." These documents are also called "advance directives" or "patient advocacy designations." This topic is timely given the growing health care reform debate and concerns about so-called "death panels."
Miller's father was 88 and had multiple health problems when he was hospitalized. He did not, however, have a terminal illness. Miller and his brothers soon discovered that they would need to make decisions about their father's health care.
Their father was comatose, on a ventilator, and unable to participate in these decisions. Fortunately, he had given one of his sons a medical power of attorney to make decisions on his behalf. Unfortunately that document only granted authority. It did not describe specifically the kinds of medical treatments and procedures their father wanted in this situation.
Miller's father had spoken only vaguely to his children about how he wanted to be treated if he were unable to make medical decisions for himself. Miller says: "A document spelling out what our dad wanted in medical care, though, would have made our decision-making a little easier."
Miller points out that only about 25% of Americans have an advance directive. Fortunately, it is not difficult to execute a living will or advance directive. Such a document allows you to express your ideas about what kind of treatment you would prefer if you're unable to make decisions for yourself and to designate a person to make decisions for you if you're incapacitated. You may decide whether or not you want treatments such as a ventilator, tube feeding, hydration, etc.
These documents may also define treatment based upon an assessment of your condition. In other words, you can designate different levels of "extraordinary measures" depending upon whether there is a likelihood that you can recover or whether this is definitely a situation where you're not going to get better and life can only be prolonged.
You can change an advance directive at any time, or cancel it. If you can answer medical questions yourself and are competent, you can verbally revoke the advance directive if you wish and medical caregivers will follow your instructions.
I was grateful that my parents had written advance directives with very specific instructions. Each had designated my sister Jill and me as co-patient advocates. We knew exactly how they wanted to be treated when it was obvious that the end of life was near. It made our decision-making much easier because we were carrying out their wishes and honoring the decisions that each had made when competent.
Different states have different laws and you might wish to consult a lawyer. However it is not required that you have a lawyer to execute an advance directive. State-specific forms can be obtained from a hospice organization, a hospital, or state aging office. The National Hospice and Palliative Care Organization offers free forms at http://caringinfo.org/. Note that there are also some very helpful articles on the caringinfo website to help family caregivers decide just how to approach the issue of making a living will with an aging parent.
A document local residents may obtain free of charge from any Munson Healthcare facility is "Five Wishes." This advance directive has been called by many "the living will with a heart." If you can't stop by Munson to pick one up, you can order one online at http://www.agingwithdignity.org/ for a nominal charge of $5.00. Or download it here. http://tinyurl.com/yljkc2t
Miller's article "Dollars & Health: Living wills, death panels and my dad" may be read here. If you are undecided about whether to make an advance directive, I encourage you to read it.
For another perspective on end-of-life treatment and health care, see this blog article "Whose Death Is It Anyway?" By Tara Parker-Pope -- New York Times Health blogger. There she writes of a patient who, while competent, chose Hospice over invasive cancer treatments.
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