DEAR DOCTOR K:
What are a living will and a health-care power of attorney?
A living will and a health-care power of attorney are both types of advance directives — written, legally binding documents. They allow you to describe what kind of medical care you hope to receive if an accident or illness renders you unable to communicate.
The biggest misunderstanding I’ve seen in my patients is that only the elderly or very ill people need advance directives. That’s definitely not the case. In fact, the younger you are, the more you may have at stake. A serious accident or injury could result in decades of life without decision-making ability.
- A health-care power of attorney permits you (the principal) to name a health-care agent (sometimes called a health-care proxy). Your agent will make medical decisions on your behalf if you are unable to make them yourself.
If you haven’t chosen anyone, a relative or court-appointed guardian who does not know your wishes may be asked to make medical decisions for you. Or a doctor may want all of your close relatives to agree before following any of their instructions. Conflicts may ensue; decisions may be delayed. I’ve seen this happen many times, and it’s bad for everyone involved.
- A living will allows you to describe your goals for medical treatment, your religious or spiritual beliefs, and any guidance you wish to give regarding your medical treatment in various scenarios that may arise. This document is often used to determine how aggressive you would like your medical treatments to be as the end of life nears. I suggest that people make out a living will to guide their power of attorney, if they have appointed one.
For example, your living will should state clearly if you:
- Do not want to be given life-sustaining care using equipment such as kidney dialysis machines or machines that breathe for you;
- Do not want to be resuscitated (brought back to life) if your breathing or heart stops;
- Do not want to be given artificial hydration and nutrition through tubes placed into your stomach;
- Do not want to receive food and liquid by mouth;
- Do want to donate an organ to be transplanted into another person, if you die.
Some people worry that filling out advance directives means giving up control over their medical treatment. In reality, advance directives help you gain a measure of control over your health care. That’s why my wife and I both have them.
Also, as long as you are able to make and communicate decisions, your word overrides anything you’ve written or told others. Only when you’re unconscious or are unable to make your wishes known does any advance directive swing fully into effect. And if your medical condition improves, and you can communicate again what you want, your decisions will again take precedence.