Throughout the #shareandprepare series, we’ve stressed the importance of writing down end-of-life care wishes. These written instructions, called Advance Directives, are legal documents that communicate wishes in the event that a patient is unable to speak for themselves. “The Advance Care directive is the combination of the durable power of attorney and the living will,” say Deb Schuster, an elderly law attorney practicing in both Illinois and Missouri. “The reason why we combine the documents into one is that they all pertain to the topical area – treatment. And, they all go to the same individuals who ultimately will need that information.”
For Schuster, advance care directives are important for not only those thinking through end-of-life decisions, but any adult. “Anyone above the age of 18 should have one,” she says. “They are absolutely essential in my mind.” Advance Directives help protect patients’ care wishes and prevent potential stress on families. They also avoid the possibility of going to court, a process which can be emotionally stressful and time consuming. Durable Power of Attorney (for healthcare): A Durable Power of Attorney is a document that identifies, in writing, a healthcare agent - someone designated to make medical decisions if a person is unable to make decisions themselves. An agent can be a close relative or friend; however, keep in mind that it cannot be a patient’s physician.
It is important that this person is calm and knowledgeable. “It really needs to be someone who is local,” says Schuster. “So, they can respond to an emergency quickly. They also need to honor someone’s wishes – to know their preferences – even when it’s difficult.”
A common misconception about durable power of attorney is that spouses can automatically make end-of-life related decisions, but, this is not always the case. Some states, like Illinois, do have surrogate laws that provide a hierarchy of decision makers if a durable power of attorney has not been designated. Missouri, however, does not have such a law.
“This is the primary reason to have Advance Directives,” says Schuster. “It’s emotionally draining and stressful to have to go to court.”
Living Wills: Once a healthcare agent has been selected, it is then important to create a living will, which officially documents end-of-life care wishes. “The living will is intended to essentially speak to the individual’s health care providers and tell them what kind of end-of-care treatment they do or do not want”, explains Schuster.
Before living wills can inform medical decisions, two physicians must certify that:
the patient cannot make medical decisions
The patient is in a medical condition specific by the state’s living will law (such as “terminal illness” or “permanent unconsciousness”)
Living wills can be as broad or as detailed as the patient wants them to be; but, because it is impossible to predict what kind of situation might call for a living will, Schuster recommends thinking through more details. “I get very specific with my clients,” she says. “We think through different scenarios… if this happens to you, what kind of quality of life would you want?”
A lawyer does not need to be present when creating a living will, however each state has different laws concerning living wills and advance directives. We encourage patients to consult their state’s attorney general’s website, as it’s easy to find resources there. For example, the state of Missouri has provided great resources for creating state specific advance directives.
All in all, an advance directive is used as an additional support during the end-of-life process.
“It’s always important that people really talk with their family members and physicians,” says Schuster. “These documents are only used on top of the conversations they have with their loved ones.”
While the process walks through many in-depth questions that are often sensitive and difficult in nature, we believe it is an important process to navigate.
Our staff is happy to help our patients and their families throughout the entire end-of-life journey.