Advanced Health Care Directives – Misunderstood and Underused

StethoscopeWhat is a Health Care Directive or a Living Will?  It’s a written direction that specifies “the kind of care you’d want at the end of life if you couldn’t speak for yourself.”  That seems like something that every single American would want to have and in fact almost all 50 States have made the form and procedure very simple and inexpensive.  Yet it is estimated that less than one-third of Americans have Health Care Directives. [See a thoughtfully written article by Melinda Beck entitled Preparing for the Final Hours, which appeared the Wall Street Journal on August 18, 2009.]

Where is the disconnect and why aren’t Americans using this very basic planning tool? Ms. Beck gives some insight. “Many people don’t understand the options or the consequences, or they are baffled by the legalities. . .”  People think the Living Will or Advanced Directive is about dying and for the young that often doesn’t seem real, and as we get older we often don’t want to think about that and we certainly don’t want to talk to our parents or loved ones about dying. The Advanced Directive is much more about care and how we live our last days than it is about dying.

There are many options we have and they are very personal to each of us.

  • How we are cared for if we become sick? Do we
    • want to be put on a ventilator
    • receive cardiopulmonary resuscitation
    • artificially receive food or water
    • can life supporting measures be started and then stopped, if they are not doing any good
    • want pain medication even if it will put us to sleep
    • want pain medication even if it will hasten our death
  • Do we want to die at home

These are all very important and personal decisions and we often fail to take into account how our families will handle our illness or death. It is a loving and compassionate gesture to our families to let them know what our wishes are. It removes a huge burden from our family if we give specific directions. It helps remove disputes between family members about what to do.

Health decisions can be made alone without an estate plan, but they are an important part of estate planning and the health care documents are put together right along with the wills, trusts and other estate documents.  The health package often includes the Health Care Directive, HIPPA Waivers and I generally include a separate Medical Power of Attorney which, while it overlaps with the Health Care Directive, provides more detail about specific medical powers.

In the estate planning process, much of the focus is about property. Who we want to receive our property and when, how to avoid taxes, what to give to charities, etc.  However, I often come away believing that the discussion and decisions about medical care, dignity, and making those tough decisions so that our families don’t have to is the more important part of the plan. Everyone older than 18 should make their wishes know in this very important area.

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