To Ensure Your End-of-Life Wishes Are Honored, a Directive May Not Be Enough

Do you want to live out your last days hooked up to a ventilator or a feeding tube?  Whether you want your life to be extended as long as possible or whether you want no life-sustaining measures at all, you need to make your wishes clear beforehand.  Chances are you won’t be able to express yourself when a crisis is at hand and a decision needs to be made. 

The traditional way to communicate one’s wishes is through an advance directive, and a growing number of Americans have these documents.  But while advance directives are a good start, by themselves they may not guarantee that your wishes will be followed.  These documents and "living wills" provide general guidance on what type of care a patient would like, but they are not consistently followed, in part because they don't give health care professionals explicit instructions for making critical decisions about a patient's care.  

Moreover, these instructions can’t give medical personnel any guidance if they can’t be found when they are needed.  Too often, advance directives are signed and then stashed in a safe deposit box or a file drawer.  Sometimes, even the treating practitioner overlooks it.  A recent New York Times article relates the tragic story of a 79-year-old nursing home resident with advancing dementia who was sent to the hospital with a persistent nosebleed.  The man ended up getting a tracheostomy and a feeding tube.   Two weeks later his doctor found in the man’s medical chart an advance directive requesting no life-prolonging treatment.  The man had never shared the document with his son, who had authorized the invasive procedures.

There are two ways to better ensure this doesn’t happen to you.  The first is to name a health care proxy – a person (or more than one person) who will make medical decisions for you when you can’t.  But beyond naming this agent who will act in your stead, you need to have an ongoing conversation with this person or persons about the kind of care you want.  When a medical crossroads looms, these people will know what to tell practitioners about the sort of treatment you would and would not like.

The second strategy, one for patients who are already seriously ill, is an alternative to the advance directive that has emerged in recent years and has been implemented or is being developed in some 40 states: the Physician Orders for Life-Sustaining Treatment (POLST).  The POLST – also called the MOLST in New York, MOST in Colorado and LaPOST in Louisiana -- uses a standardized medical order form to indicate which types of life-sustaining treatment a seriously ill patient wants or doesn't want if his or her condition worsens. The POLST can serve the same function as a state do-not-resuscitate form if a patient is rushed to an emergency room.

The POLST is particularly welcome in nursing home settings because the common practice is to do everything possible for patients despite the fact that only about 12 percent of nursing home patients want intensive care treatments, according to one study.  For details on the POLST, click here. 

Talk to your elder law attorney about drawing up the documents to help ensure you receive the end-of-life medical treatment you want -- no more and no less.

For more on end-of-life decision making, click here.

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