Advance medical directives and end-of-life plans are two of the most important documents a person can create. They ensure your wishes are carried out with respect to your values if and when you can no longer speak for yourself. Failure to complete these documents means your grieving family members or closest loved ones must make decisions for you, and they may not make decisions in alignment with your preferences.
Advance Directives & End-of-Life Planning
Today, we’re going to explore these two estate plan fundamentals so you can begin planning for the highest quality of life while keeping the end in mind.
Advance directives, also called advance medical directives or medical directives, let your loved ones and primary healthcare providers know what you want (and what you don’t want) when it comes to life support and life-saving measures if you are incapacitated and can’t speak for yourself. They are legal documents, and healthcare professionals adhere to them when they are made aware of them.
As with all wills, trusts, and most other estate plan documents, your advance medical directive is a living document that you can change as time moves on. For example, in our practice, we observe that parents with younger children may create advance directives with more life-saving measures in place. At the same time, seniors in their 80s or 90s often change medical directives to become “Do Not Resuscitate (DNR)” requests because they aren’t interested in the potential suffering or aftermath associated with extreme life-saving measures at that stage of your life.
Regardless of your decision, your final advance medical directive should be shared with your spouse/partner, adult children, and close family members, as well as with your estate planning attorney, trustee/executor, and any primary healthcare providers. If you change the document, make sure you send revised copies to all of the above. In case multiple versions are presented in the hospital or ICU, medical administrators honor the most recent version.
Questions to consider when creating your advance medical directive
First and foremost: Who is your designated healthcare agent or proxy? As with choosing a trustee or durable power of attorney, this is not always as straightforward as you might think. You want someone who is 100% dedicated to your choices, regardless of whether or not they conflict with the proxy’s feelings. If you wind up in a complicated medical situation with multiple paths forward, your healthcare proxy needs to remain clear-headed and objective enough to carry out your requests, which means immediate family members may or may not be the best choice.
From there, it’s time to perform deep inquiry about what you really want if you are in a serious medical scenario and lifesaving measures are required. For example, if you were in a car accident and needed life support, how long would you want to remain hooked up to ventilators or feeding tubes? How many times are you willing to be resuscitated? Without proper documentation, you may be placed on life support indefinitely.
We recommend visiting deathwithdignity.org for more detailed information about advance medical directives or meeting with a qualified estate planning attorney. It’s helpful to bring these answers with you as you and your attorney work together on your estate plan.
In the meantime, some of the most important questions to consider include:
- What is “quality of life” as you define it? What personal/physical/mental/ability losses would make you feel it’s your time to go versus scenarios in which you’re willing to keep fighting for more time?
- Would you want CPR or other resuscitation if your heart were to stop beating? If so, how many times?
- Would you want to be put on a ventilator if you could no longer breathe on your own? If so, for how long, and what would be the point you’d want the ventilator removed?
- Would you wish to have tube or needle feeding if you lost the ability to swallow? If so, how long are you interested in living with tube or needle feeding if you cannot communicate?
- If you had a life-limiting illness, would you wish to receive antibiotics that might prolong life? i.e., if you’re rushed to the hospital with an infection related to your life-limiting condition, would you want antibiotics or any other life-extending treatments?
- If you had progressive dementia, what health treatments would you want? At which point with dementia or another form of memory loss or cognitive loss would you prefer to die naturally without forced feeding/hydration/life-sustaining medications?
- Would you want to be an organ donor? If so, are there any organs you don’t want to donate?
- At what point would you want palliative care (care that focuses on pain control and quality of life) rather than aggressive treatment? At which point would you want to engage hospice care services (focusing on pain and quality of life but without curative treatments)?
These are not easy questions to review, and yet failure to do so puts your closest and most immediate loved ones in a terrible and traumatic position of having to make these decisions for you. That devastating situation is made even worse when there are disagreements. As with all aspects of estate planning, your proactive tackling of these documents creates peace of mind and simplicity for your loved ones.
While some aspects of your estate plan may be private, we always recommend sharing information about your medical agent/proxy and advance medical directives with family members ahead of time so they are clear about your wishes and can discuss any concerns they may have.
It’s never too early to create end-of-life plans
The Death With Dignity organization also has a wonderful guide to creating end-of-life plans, complete with a checklist. Regardless of the fact that we all know we’ll die someday, research shows that more than 70% of Americans die without any advance directives or end-of-life plans. This puts their family and close friends in a difficult position.
End of life plans encompass everything from instructions on where your estate plans are located and advance medical directives to the types of things you want to have in your environment when you’re dying (music playlists, candles, flowers, images, comforting pjs or blankets, essential oils, people, etc.). You can also specify what you don’t want as you’re dying.
Then, the plans take things one step further to outline how you want your body prepared and disposed of. Today, more people are choosing green burial and cremation options, which requires more research and planning. By taking this on before you are dying, you become an active participant. You can even be a part of writing your own obituary, planning your celebration of life or funeral plans, deciding the type of legacy you’d like to leave for friends and family members, and so on.
Let Tseng Law Firm Guide the Way
Are you ready to take a proactive approach with your advance medical directive and end-of-life planning documents? Let Tseng Law Firm guide the way. Contact us to schedule a free, 30-minute consultation, and let’s get started providing peace of mind for you and your loved ones.