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Preparing an Advance Directive

Planning for end-of-life care ensures your final days will be lived with dignity.
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WebMD the Magazine - Feature

When Terri Schiavo died in the national spotlight in 2005, after lingering in a vegetative state for 15 years, interest in living wills -- one form of advance medical directives that allow people to specify their wishes for medical treatment at the end of life -- surged. Newspapers even reported “living will parties,” where friends snacked on brie and sipped wine while discussing respirators and resuscitation.

Experts agree it’s important to plan for end-of-life care -- if only to spare your family the fate of Schiavo’s relatives, who squabbled for years in the courts before doctors removed Terri’s life support in 2005. But adequate planning isn’t as easy as checking a few boxes over a glass of chardonnay.

So what should you do to prepare? Many experts suggest filling out three of the most common advance directives used for end-of-life care:

Living wills typically specify medical treatment that is desired (or not desired). For example, you might state that certain life-sustaining measures that serve only to prolong your dying be withheld or discontinued.

Health care surrogate forms (or health care proxy forms) designate a person who will make health care decisions for you if you become incapacitated. The health care proxy has, in essence, the same rights to request or refuse treatment that you would have if you could decide for yourself.

A durable power of attorney allows an individual you designate to do certain tasks in your place, such as signing Social Security checks, applying for disability, or simply writing checks to pay bills. 

One caveat: The problem with living wills is that the meanings of terms such as “terminal condition” or “artificial procedures” are debated by doctors and fought over in court, says Scott Solkoff, a Boynton Beach, Fla., lawyer who specializes in elder law. And many doctors ignore the wills for fear of lawsuits by surviving relatives. Solkoff’s solution: Modify the standard form to be as specific as possible — and add a clause releasing your doctor or hospital from liability for following your wishes.

Also, choose a strong-willed surrogate, suggests Joan Teno, MD, a leading end-of-life researcher at Brown University. It’s not enough that he or she understands your wishes; that person may also have to take a firm stand if a doctor suggests a procedure you wouldn’t want.

Finally, start a conversation with your doctor now about end-of-life care and your wishes so you both know how to proceed.

Reviewed on April 03, 2007

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