Planning for End-of-Life Care

Death is inevitable and irreversible. It is, perhaps, the one thing we all have in common and an event for which people often prepare. This is especially true if you have a terminal illness or other medical condition requiring extra medical care as you approach the end of life. Advance care planning offers peace of mind as you face death.

Advance care planning can include advanced directives such as:

• A living will
• A durable power of attorney
• Physician orders for life-sustaining treatment
• Do not intubate order (DNI)
• Do not hospitalize order (DNH)
• Do Not Resuscitate Orders (DNR)

This FindLaw article explores advance directives, including different types of advance directives and legal considerations.

Understanding Advance Directive

An advance directive is a legal document that explains your health care decisions in case of an emergency or as you approach end-of-life and cannot participate in your health care decision-making. It provides direction on preferred medical treatment and your preferences regarding artificial support. 

Your entire healthcare team, including medical providers, must honor your instructions or find a team that will. It is essential to create these documents in advance of needing them. This helps ensure your decisions guide your medical care if you lose the capacity to make these decisions.

Types of Advance Directives

The main types of advance directives include the following:

• Living wills
• Durable powers of attorney (health care proxies)
• Do not resuscitate orders

The key with advance directives is incapacity. Advanced directives apply when you cannot make decisions for yourself. Advance directives can provide direction on the following:

• The care you would like to receive
• The types of treatment you would ​not like to receive
• Your preferences regarding artificial life support

Your advance directive can apply to physical or mental health issues. The key is addressing potential issues well before needing a directive.

Once a doctor receives a properly executed advance directive, they must honor its instructions or transfer your care to a physician who will. 

Many healthcare facilities will keep your advance directive as part of your medical records. This helps ensure that the healthcare professionals involved in your care honor your wishes.

Living Wills

A living will is a legal document that comes into effect in one of the following situations:

• You are terminally ill
• You are unable to make your own decisions
• You have lost consciousness

Terminally ill persons have less than six months to live per a physician's diagnosis. Directives to physicians or health care directives are two alternative names for a living will. Most people create a living will well in advance of needing it. A living will covers many of the following end-of-life care issues:

• Use of feeding tubes or ventilators
• Resuscitation orders
• Organ donation

In a living will, you describe in advance the kinds of treatment you want or do not want. For example, you can decline to have life-sustaining treatment or indicate your acceptance of placement into a nursing home for long-term care.

You cannot use a living will to appoint a healthcare proxy to make medical decisions on your behalf. You can make such appointments in a durable power of attorney, also sometimes known as a healthcare proxy.

While a living will allows you to describe in advance the kind of treatment you want or don't want to receive, it doesn't allow you to appoint a person to make medical decisions on your behalf. For that, you'd need a durable power of attorney.

Durable Power of Attorney

A durable power of attorney for health care or healthcare proxy allows you to decide on future healthcare needs. In this aspect, it is similar to a living will. A durable power of attorney also allows you to select a caregiver, friend, or family member to make medical decisions on your behalf. This person is your healthcare proxy, agent, or surrogate.

You can give your surrogate as much or as little power as you'd like. For example, your durable power of attorney can state that the surrogate may decide when your healthcare professionals can stop your treatment.

When selecting a healthcare agent, talk to your prospective healthcare agent first. Make sure they will honor your wishes, even if they disagree with them.

You can check your state laws for more specifics on creating a durable power of attorney.

Do Not Resuscitate (DNR) Orders

DNRs are advance requests not to have cardiopulmonary resuscitation (CPR) or advance cardiac life support (ACLS) if your heart stops or you stop breathing. DNRs are essential for those who don't want to have this potentially life-saving measure. Without such a directive, healthcare professionals will attempt to revive non-responsive patients.

There are several ways to create advance directives. Many healthcare facilities have advance directive forms you can fill out. You can also ask your physician or a healthcare team member to note your decision in your medical chart. The key is to create an advanced directive, such as a DNR, while you are competent to make the decision.

Advance Care Planning Benefits

There are many benefits to advanced care planning. The most important benefit can be viewed as peace of mind. An advance directive may save your loved ones from protracted arguments and anxiety over your care. Most importantly, advance care planning allows you to choose who makes medical decisions on your behalf.

With an advance directive, you may experience a sense of relief knowing that you won't be subjected to unnecessary or personally objectionable treatment. Without one, you may have to rely on your physician's discretion to make decisions about your health care. Having an advance directive may save your loved ones anxiety, concern, and arguments.

Essential Considerations With Advance Care Planning

In drafting an advance directive, realize that medical choices and treatments available today may be unavailable in the future. You'll either need to update your directive as new developments in medical technology and treatment become available or draft your directive in such a way as to include newly developed treatments.

Specify Pain Treatment Preferences

Most state laws presume that people want relief from pain, so those items are not included in the definition of life-prolonging treatment. If you don't want to receive pain medications, you should make that clear in your directive. In some states, the same goes for food and water.

Consider All Possible Scenarios

Making sure that your advance directive protects your wishes is a difficult task. For example, will receiving life-prolonging treatments depend on what your quality of life might be? Would you rather not have treatment if it means it could keep you alive but in a permanent coma? What if you couldn't feed yourself? Breathe on your own? Would you want to have life-saving treatments for a short period or not at all? 

Talk to Your Doctor

In many situations, discussing your treatment wishes with your primary care physician or healthcare provider is a good idea to protect your patient rights. If you have a terminal illness, your physician can do the following:

• Review your diagnosis with you
• Provide essential advice on what types of treatment you may need
• Discuss with you the effect those treatments might have on you

Having your durable power of attorney with you for these conversations can make sure your wishes are understood.

Legal Requirements for Advance Directives

As with other healthcare-related matters, state laws govern living wills and durable powers of attorney. However, most states have the following legal requirements:

• You must be 18 (some states allow parents to draft advance directives for their minor children)
• You must understand the following:
  • What the document means
  • What it contains
  • How and when it applies
• You can change your mind, but you should destroy all copies of any old directives and write a new one instead of trying to amend
• Sign the advance directive in front of a witness, a notary public, or both

For more help in creating advance directives, the following organizations can assist, including offering sample forms:

• National Hospice and Palliative Care Organization
• American Association of Retired Persons
• Veterans Affairs 
• National Institute on Aging

Get Legal Help

Advance care planning allows you to prepare for your future and the important decisions that will have to be made about your health care. This planning helps ensure that healthcare professionals honor your wishes and protect your family from making critical decisions without your input. 

An experienced healthcare law attorney can help you discuss and create advance directives. Speak to an experienced healthcare attorney to protect your civil rights.