Living Will: Advanced Medical Directive

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The Living Will (or Advance Medical Directive) is a document in which you state your wishes regarding the continuance or refusal of extreme medical care, or just how much life support intervention you want prior to death as you age or if you become seriously ill. It comes into play only if and when you cannot make those decisions yourself. If you become incapacitated, with no possibility of recovery from mental or physical disability, would you prefer to live or die? This hard question, once answered, will determine the directives you set forth in your Living Will.

How to talk about dying An article in the New York Times by Ellen Goodman, How to Talk About Dying, looked at this question in retrospect from a child’s perspective recalling her own mother’s health decline:

Yes, my mother and I talked about everything — but we didn’t talk about how she wanted to live toward the end. The closest we ever came to discussing her wishes was when she would see someone in dire straits and say, “If I’m ever like that, pull the plug.” … Gradually and painfully, my mother lost what the doctors call “executive function,”… Eventually, she couldn’t decide what she wanted for lunch, let alone for medical care.

The same person that you are today, or you know today such as a parent, may not be able to make both financial and health care-related decisions due to a decline in health. You can decide in advance what medical treatments and care are acceptable and for how long. For example:

• If you heart stops or you stop breathing do you want to be resuscitated?
• If terminally ill, do you prefer to stay at home or be hospitalized?
• Is special care or medicine for a rare disease affordable?
• Is owning Long-Term Care (LTC) or Critical Illness insurance important to your future well-being as you age or if you become critically ill?

Everyone over age 18 should have a Living Will

Many government jurisdictions are writing new laws recognizing Living Wills. Even if not yet legally binding, a Living Will allows you to indicate your wishes providing guidelines for your family physician, family members and friends—those who would be asked to make health care decisions on your behalf.

Formulate your Living Will with a lawyer (or on your own) and discuss it with your potential decision-makers. Give each of them a copy, updated when necessary, for reference. Have at least two of them witness each copy.

The Living Will alleviates the heavy burden of a son or daughter or sibling, deciding to allow a loved one to die. By setting forth your request in advance with a clear mind, you intentionally share in that great responsibility, thus lessening any feelings of fear, guilt or indecision that these people may have to face. In the same article mentioned above, Ellen Goodman reflected on her mother’s situation in light of historic health decisions and recalled her earlier statement about what she didn’t want to endure:

In some recess of my mind, I still assumed that death came in the way we used to think of as natural. I thought that doctors were the ones who would tell us what needed to be done. I was strangely unprepared, blindsided by the cascading number of decisions that fell to me in her last years….I had to say no to one procedure and yes to another, no to the bone marrow test, yes and yes again to antibiotics. How often I wished I could hear her voice in my ear telling me what she wanted. And what she didn’t want.

Ellen’s reflections may help us think about our own reality, our own health care directives which in most cases can’t be thought out if someone is mentally incapacitated, or if an emergency health crisis ensues – then it may be too late – when the burden falls on our loved ones.

My own sister, a nurse, felt she had to make the right decisions to keep my own beloved mother alive. More than once she was faced with the frightful case of dialoguing with doctors about reviving my 81-year-old mother, who had taken a serious fall causing internal bleeding of the brain. Mother went through three years of being in several hospitals, then and Long Term Care homes. I vividly recall mom saying of a woman who sat muttering incoherently in her LTC home, in her own humorous words: “if I get like that, let me go”. I agree with Ellen Goodman’s statement:

When my mother died from heart failure and dementia, I began to talk with others. It was extraordinary. Everyone seemed to have a piercing memory of a good death or a hard death. Some of these stories had been kept below the surface for decades, and yet were as deep and vivid as if they’d just happened…Too many people we love had not died in the way they would choose. Too many survivors were left feeling depressed, guilty, uncertain whether they’d done the right thing…The difference between a good death and a hard death often seemed to hinge essentially on whether someone’s wishes were expressed and respected. Whether they’d had a conversation about how they wanted to live toward the end.

Talk to your life insurance advisor about Long Term Care, which is appropriate for your advanced medical directives. Also, talk to your lawyer about creating a Living Will to develop advanced medical directives while you are coherent and able to do so. Then let your loved ones know your wishes and give them a copy.

by Glen Jackman, Editor of Adviceon Media, copyright of Adviceon

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