Making Your Last Wishes Known
Make sure you discuss your wishes with your doctors, proxy, and family
members -- in part so they won't try to contradict your instructions later.
"The completion of a health care directive doesn't end when you sign the
document and put it in a drawer," says Carol Sieger, staff attorney with
Partnership for Caring. "Paint a picture about what's acceptable and not
acceptable, what your personal values are, your idea of independence. What are
your wishes regarding care? What do you view as quality of life? "
No matter how complete your living will, you won't be able to address all
possible scenarios. "People don't have crystal balls," says attorney
Charles Sabatino, counsel to the American Bar Association Commission on Legal
Problems of the Elderly. "Each medical decision is unique and fairly
complicated. I've never seen a directive that didn't take serious
interpretation to figure out how to implement it."
That's one reason to carefully consider your choice of a proxy; Sabatino
calls it "the most important decision you're going to make." Choose
someone you trust implicitly but remember -- the person closest to you may not
necessarily be the best option. For instance, your loving wife or grown child
may be so unwilling to let you die that they'll want to resuscitate you even if
you're past recovery. When you've made your choice, make sure he or she knows
your philosophy about end-of-life treatment.
Because values and wishes change over time, you should revisit your advance
directive every few years and certainly after a major life change, illness, or
death in the family. "If you don't update your instructions periodically,
people will doubt those are still your wishes," says Sabatino.
Regardless of their imperfections, an advance directive "remains the
clearest and best avenue for insuring that patient wishes are honored at the
end of life," says attorney and bioethicist Paul W. Armstrong. "Granted
there are difficulties with them, but there should always be deep ambivalence
about making end-of-life decisions."
Loren Stein, a journalist based in Palo Alto, Calif., specializes in health
and legal issues. Her work has appeared in California Lawyer, Hippocrates,
L.A. Weekly, and The Christian Science Monitor, among other