Do you have strong opinions about extraordinary life-sustaining measures? Have you ever said to yourself, “If she needs a machine to keep her alive, what’s the point?” Has a sibling ever joked to you, “If they ever try to put a tube in my throat to feed me, it’s time to pull the plug?”
Here’s where a living will (also known as an advance health care directive) comes in. It can be a key part of the life-care planning process. And make no mistake, it’s not just a do-not-resuscitate (DNR) order. The will to live does not constitute a living will.
So What is a Living Will and What Does It Do?
Now let’s for the moment imagine the worst — from your perspective. You’ve just been in a terrible automobile accident. You’ve been severely injured, and it’s not clear how long you may live. You may need a ventilator to breathe, and you may need to receive both fluids and food through a feeding tube.
You are unconscious and unresponsive. You are unable to tell the doctors what you do or don’t want done to keep you alive and/or comfortable in what could be a short or very long time.
So what happens? Who will end up making those decisions for you? Your doctor? Parents? A girlfriend, boyfriend, spouse or life partner? A sibling? Now ask yourself this question: Can all of these persons be counted upon to make decisions based on what YOU would want? Do religious differences between yourself and any of these people make it possible that they would be unable to carry out your wishes â€“ if they even know your wishes? Hmmmâ€¦
Oh, the anxiety! But the silver lining is that by going through this thought process, you now have some very good food for thought.
Now Let’s Switch the Focus to Your Loved One
What does being “prepared to die” mean? Your loved one may require spiritual and emotional preparedness, but there are also critical needs regarding practical and physical preparedness. And it may surprise you the extent to which being physically prepared can help with the less tangible aspects of preparedness for death.
There are many practical aspects to planning for one’s passing.
So What is a Living Will?
A standard or testamentary will (“last will and testament”), directs how assets will be utilized and distributed after death. It may include care elements, but this is not a living will (or advance health care directive).
A living will is a legal document (care partners should have access to several of them in end-of-life scenarios) detailing a loved one’s desires and preferences regarding their medical treatment, prepared for use in circumstances in which they are no longer able to express informed consent.
Who Should Have a Living Will?
EVERYONE! Alright, let’s say you don’t happen to have strong opinions on what happens to you when you are unconscious or in a coma. But think about the people in your life on whom these difficult decisions will almost certainly fall. These issues can translate into heartrending and devastating choices — if the care-partner team is not prepared. If nothing else, prepare a living will in order to spare loved ones from being forced to make such decisions at an already stressful time.
What’s the Difference Between a Living Will and a Health-Care Proxy?
Living wills often encompass the naming of a health care proxy (or proxy directive). This is a person chosen to make decisions about medical treatment when a loved one is no longer able to do so. So, a living will is a document, while a health care proxy is an individual who may be named within the document.
Naming a health care proxy is a key way to manage the health care decisions in the event of a loved one’s incapacitation (due to either life-threatening injury or terminal illness). The first goal of a health care proxy is to keep the decision-making as close to the affected individual as possible. It is important that this individual be someone with whom the care recipient and rest of the care-partner team are comfortable.
But there are other important considerations. The right person will be someone who knows the individual well and has been a part of their life for a significant time. Physical proximity and access should also be important considerations. But their closeness must not overpower their ability to render tough decisions. They must be prepared to act — out of love — to cease treatment or life-saving actions, if necessary.
A health care proxy is an especially good idea if there is more than one important family member or friend in a loved one’s life. A spouse or a life partner, and by extension, their own family, may feel very much a part of your loved one’s life and therefore may want to share in the decision-making around death.
Some people who were not particularly close to their families may have what is referred to as a “chosen family.” This close-knit group of long-time friends may be included in a living will to act as next of kin.
In some situations — divorce or an LGBTQ+ family member, for instance — there may, unfortunately, be conflict between the families involved. In some cases, end of life may be a point at which two families in a loved one’s life first meet one another.
These are situations where it’s imperative your loved one name one person who is indisputably in charge of health care and end-of-life decisions. For better or worse, remember death is often a time when long-simmering family disputes can erupt into open hostility. Having a health care proxy in place can help to neutralize potential powder-keg situations.
Who Prepares a Living Will?
At Caregiver Support and Resources, LLC, we facilitate the preparation of a living will as one component of a comprehensive life-care plan. Think of a life-care plan as the strategic roadmap for your loved one’s Golden Years. Our individualized Life-Care Plan has three primary objectives:
- To create a personalized care plan that ensures that the loved one is well known by all the individuals and agencies who are there for support. This may include written documents and/or videos detailing the individual’s history, likes and dislikes, wants and needs, including the living will and/or proxy directive.
- To ensure your loved one gets appropriate care — whether at home, in a care community, or in hospice or palliative care, regardless of location — to maintain a life worth living at a cost they can afford through public and private assistance.
- To provide the care-partner team with supportive tools.
The Many Benefits of a Living Will
- All parties involved know your wishes and preferences regarding medical treatment.
- The family and other members of the care-partner team can be confident in the outcomes of medical care.
- Get the treatment desired; refuse the treatment undesired.
- A living will delegates decision-making and avoids conflict among family members and friends.
- Takes some of the stress out of a very difficult time and can provide all concerned with some much-needed peace of mind
Some Things to Remember About a Well-Planned Living Will
Make sure EVERYONE involved with end-of-life planning knows of the existence of the living will! Living wills, like standard wills, are often kept locked up in safes with other important family documents. They may be forgotten. They may not surface until after a loved one has become incapacitated, negating some of its purpose.
Don’t let that happen!
Don’t forget to make a reference to new treatments in the living will. There may be new treatments that are developed after it may seem to be finalized. Include a provision that says that new treatments that are deemed by your loved one’s doctor as possibly beneficial should be made available.
Living wills are traditionally prepared by lawyers or financial planners â€“ folks who may have limited knowledge about your loved one and the care-partner team. Caregiver Support and Resources, LLC has over 25 years of experience with all aspects of life-care planning and team building, as well as Medicaid planning (with asset protection) and patient advocacy. We are happy to guide the process in a caring and compassionate way.