In previous columns, I’ve discussed how you can set up a do-it-yourself estate plan or pass on property to a spouse, and when you actually need a will. I’ll wrap up this estate planning series with a look at what may be the most important document you may ever sign: the living will and advance health care directive.
A living will is your way of telling medical professionals and your loved ones what you want them to do when you’re unable to tell them yourself because you’re in a coma, have had a stroke, or are in any situation where medical professionals and your families have to decide what measures to take to either save your life or ease your pain.
A study published in 2014 found that only 26% of the U.S. adult population had some form of advance directive, although nearly eight in 10 people in residential care facilities had such directives in 2016, according to the Centers for Disease Control and Prevention.
But what really counts when it’s literally a matter of life and death? I spoke to someone on the front lines who deals with these issues day to day–Jeannie Meyer, a clinical nurse specialist for palliative care at UCLA Health and president of the Los Angeles regional chapter of the Hospice and Palliative Nurses’ Association.
Doctors, nurses and families faced this critical decision many times over the past year, when 30 million Americans were stricken with COVID-19 and tens of thousands, particularly older patients, went to intensive care units (ICUs), where they often were unable to communicate with spouses or family members about their care.
“COVID, if anything, has really brought to the forefront the importance of advance care planning, and making sure that not only are your wishes clear but that your loved ones know them as well,” said Meyer.
Many people think of these directives as “do not resuscitate” orders, and Meyer told me that patients and families even have misconceptions about that. ‘Your heart has stopped. You are no longer breathing. You have died,” she said. “What we are trying to do with a resuscitative effort is pull you back into this existence.”
And, she added, “by getting them back, I mean we get a beating heart back. I am not talking about quality of life.” Young, healthy people have a much better prognosis with resuscitation than elderly patients who have preexisting conditions, she noted.
But resuscitation isn’t the only issue you’ll need to deal with.
“We have now moved on in our advanced health care directive where what we are asking people to identify for us in most of these instances is what constitutes an acceptable quality of life for you? And if we cannot return you to that quality of life, what would or would you not want us to do if you were likely to survive in a quality of life that would not be acceptable for you?” Without a living will, she said, doctors will go all out to “save” a patient, no matter what state that person may be in afterwards.
Once you decide what you would like medical professionals to do or not to do, you need to pick an attorney-in-fact to carry out your directives. That can be a spouse or family member, a close friend or a professional who knows you well.
“Whomever you select as your decision maker, make sure that it is somebody who will be able to put aside their own interests and do what you would want them to do, because you are putting the remainder of your existence in that individual’s hands,” said Meyer.
You should also have a conversation with your spouse or significant other and your family, so there can be no misunderstanding if they’re faced with a situation in which you are unable to communicate.
None of this is pleasant to deal with, but it’s necessary, often more for the people you love than for yourself. That’s why if you’ve prepared a living will, you should review it periodically.
“It’s not a one-and-done thing,” she said. “People get divorced, decision-makers die, people have falling-outs with each other, so you need to be prepared to complete another directive. And at that time, you need to stop and think, is the quality of life that I thought was my line in the sand before still my line in the sand?”
Who should have a living will and advance care directive? Everyone over 18, she said. “So, please, please, please do it. Do it now. Don’t procrastinate. Don’t assume you have more time; you may not.”