My mother, who suffered from heart disease, always envisioned that she would die quickly from a massive heart attack. However, sadly, she lingered in poor health for many weeks before she finally passed away. Luckily, years before, she had an attorney draw up an estate plan.
Because of HIPAA laws, the nurses and doctors would not talk to me until I gave them a copy of her health care durable power of attorney. Because her doctor decided to honor her living will, she was spared from the feeding tube and received comfort care during her last pain-filled days.
Without the proper documents and consenting medical professionals, this situation could have been much worse. At minimum, you need to have a living will and a health care durable power of attorney. In some states, a Five Wishes form can be used as a substitute. In either case, you should complete these forms with the assistance of an attorney. If you choose to do-it-yourself, it's possible to omit crucial items. If you make a mistake, you will not get a second chance.
Make sure to discuss the contents of these documents with your physician. Don't assume that your physician has the same beliefs concerning "right to life" and "freedom of choice" issues as you do. If your physician does not agree with your choices, you might need to change physicians. Waiting until you are incapacitated is too late to find out that your attending physician will not provide treatment that agrees with your end-of-life choices. If possible, have your physician complete a Physician Orders for Life-Sustaining Treatment (POLST) form and keep it with your estate plan.
Make sure that your family members also understand your choices. Once again, don't just assume that they have the same exact beliefs as you. Family members could argue in court of law that you didn't fully understand the contents of your advance directives and have them revoked. Having an attorney complete your estate plan along with having your physician complete a POLST form ensures that you fully understand the contents of these documents.
You also need a clear understanding of exactly what treatment you can expect to receive at various health care institutions. For example, a hospital with a religious affiliation may choose not to honor your advance directives because the treatment conflicts with their religious doctrine. Moving an incapacitated patient to a new health care institution can be a frustrating and stressful experience at best.
Most important of all, no matter how much time you spend preparing these documents, they can't be used if they can't be found. Keep your original copies and store backup copies in a virtual safe deposit box (VSDB). It's an ideal place to make sure that your advance directives are available when they're needed most!
James Bell
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