Have questions about end-of-life care?

Curious how to prepare a personalized living will?

Doctor Robert Pearlman, and others, wrote the Your Life, Your Choices under a Veterans Administration authorized grant, which was revised in 1997. The 52-page workbook is informative and easy to read, covering the issues important to end-of-life care decision making. Topics include:

• Why do you need to think about future health care decisions?
• If you couldn’t speak for yourself, what would you want done for you?
• What situations and decisions do people commonly face?
• Your beliefs and values
• Choices about death and dying
• Talking about your wishes
• Legal and ethical issues of advance care planning

Download the Your Life, Your Choices Workbook

This document should only be used as a starting point, however. The decision making and living will development should be done in cooperation with those close to you, your family, doctor, clergy, lawyer, and others you see fit. Many states also offer state specific living will documents for individuals to use. Visit the Resources by State page to find your state’s Attorney General’s Office, who should be able either provide you with a basic living will that you can complete with your preferences, or they can point you to someone that can.

A Durable Financial Power of Attorney (DFPOA) form is a legal document that identifies another person as being able to make financial decisions on your behalf should you become unable to make the decisions yourself. The “durable” means the power granted in the document remains in force should you become incapacitated. A POA that is not “durable” becomes ineffective at the time you become incompetent. This is like a Durable Medical Power of Attorney, only it deals with financial decisions, not medical decisions. The person you identify to make decisions on your behalf is referred to as your agent, and he/she is required to act with your best interests in mind, and must avoid conflicts of interest.

Your DFPOA form can specify that it takes effect when signed, or in the event you become incapacitated. The document may also speak to specific financial actions your agent can or cannot make. Examples of decision making abilities include:

• Use your money to pay everyday expenses
• Manage your retirement accounts
• Pay taxes
• Buy insurance for you
• Transfer property
• Invest your money in stocks, bonds, etc.
• Collect Social Security or other government benefits

A DFPOA form can sometimes be obtained from financial institutions, but elder attorneys will provide assistance, or you may be able to find a standard form from your state’s Attorney General’s Office. You can find your Attorney General’s contact information by visiting the Resources by State page. I would advise against using any free, standard form available online unless it’s from a reliable source and is written specifically for the state in which you reside. The document will almost certainly need to be signed in front of and by a Notary Public.

If you do not have a DFPOA and someone has to make financial decisions for you, court proceedings may be required. Having such a document in place saves your family a lot of work if it is ever needed. If you anticipate the potential need for a DFPOA, you may also consider putting a Durable Medical Power of Attorney and/or a Living Will in place at the same time.

A Living Will is a legal document signed by a person, when still of sound mind, that outlines his/her wishes for end-of-life medical treatment in the event he/she becomes severely disabled or suffers from a terminal illness. Living Wills are sometimes referred to as advance directives or health care directives. If you entered a permanent vegetative state, would you want to be kept alive by machines and feeding tubes? If you answer no, this is one example why you should consider drafting a living will; but don’t be confused by the word “Will.” These documents are not conventional Wills. If you want to transfer assets after you die, you will still need a Will or some other legal estate planning document in place.

Specifically, a Living Will outlines your desires for certain life prolonging treatments. You indicate which treatments you want applied and under what circumstances. For example, you may specify your wishes on:

• Use of life sustaining equipment
• Feeding tubes
• Pain relief
• Hydration
• Do Not Resuscitate orders

You should be very specific about the types of treatment you do or do not want. Vague language is open to interpretation. An order to withhold “extraordinary care” means different things to different people.

Legal requirements for Living Wills vary from state to state, so consult your attorney or your state’s Attorney General’s Office for specifics. You can find the link to your Attorney General through the Resources by State page. Some states recognize and offer standard Living Will forms. If you are developing a Living Will, consider developing a Health Care Power of Attorney at the same time. Some people prefer to make their wishes known to their Power of Attorney and trust them to enact their wishes rather than develop a Living Will. You can have both documents in place at the same time, and both will likely need a notary’s signature.

A Living Will is legally binding, but does not take effect unless a doctor or doctors determine you have become incapacitated and are unable to make your wishes known. They do not become effective if your medical illness or unconscious state is short-term, it’s only for permanent conditions when there is no hope of recovery. Discuss a Living Will with your doctor and become informed about the impact of your decisions. You should also involve family members. Let them know your wishes and tell them you have a Living Will and where it is kept.

A health care power of attorney, sometimes called a medical power of attorney or durable power of attorney for health care or health care proxy, is the authorization for someone to make medical decisions on behalf of another should that individual become unable to make his/her own decisions. This is different from a living will, which typically outlines an individual’s wishes should he/she become terminally ill.

A health care power of attorney form is a legally binding agreement that grants the decision making power to the specific individual (or individuals) and is signed by both parties. These forms must be notarized.

There are many places to find power of attorney forms online, and attorneys can help, but paying for the assistance is usually unnecessary. However, it is my advice that general online forms be avoided as laws may vary from state-to-state. I recommend you contact your state’s Office of Attorney General for health care power of attorney forms. You can find your Attorney General by visiting the Resources by State page. Attorney Generals usually provide these forms at no cost and they are written specific to your state. Hospitals also carry these forms.

When considering someone to become your health care power of attorney, you’ll want to identify someone that:

• You trust
• Understands your wishes and will act based upon your wishes
• Can act as an effective advocate on your behalf

Some people identify multiple individuals to make medical decisions; an example might be two adult children. My advice is to avoid identifying more than one person to act as Power of Attorney (POA). It’s unfortunate, but many family disagreements occur during high stress family medical situations. What happens if the two can’t reach consensus? You’ll do everyone a favor by NOT identifying more than one POA. Identify the second person as an alternate should your first choice be unavailable. Make the decision with the people you identify. Have a discussion with them about your thoughts on medical care, end of life care, and spiritual wishes. The discussion may be difficult or uncomfortable, but it is far better to have the discussion in advance rather than force family members to guess what your wishes might be or to enter the court system to obtain decision making power.

Specific wishes on care may be outlined in the power of attorney form or in a living will. Sometimes the two are combined into one document. If you have a living will (highly recommended) you may also add language to your health care power of attorney form that the decision making of the power of attorney shall not override your wishes outlined in the living will.

Health care powers of attorney and living wills are recommended for anyone. The future is unpredictable and uncertain; better to have the forms and not need them than to need the forms and not have them.