The last days of life often come with complex and difficult medical decisions, like whether to continue with life support. If you’ve thought about what type of care you’d like at the end of your life, advance directives can help you communicate what you want—and what you don’t.
Since acute care is common at the end of life, it’s important to think through these decisions ahead of time. A recent study found that one out of five Medicare fee-for-service patients dies in a hospital and nearly 43% of deaths are preceded by an intensive care unit stay. Even if you’re younger and healthy, unexpected end-of-life situations can come up at any time.
Advance directives are a way to communicate your end-of-life wishes now to help make sure they’re carried out later. Many people skip this step of end-of-life planning: Only one in three adults actually have advance directives in place.
Creating your advance directives can ultimately benefit both you and your family, so they don’t have to guess what you would have wanted during an already emotionally taxing time. Here’s what’s included in an advance directive and how to set them up for yourself.
What is an advance directive?
An advance directive is a written statement of your wishes for medical treatment in case you aren’t able to share those directions with your doctor. These kinds of documents originated in the 1960s to give people a legal way to share their end-of-life desires, with a goal of increasing the number of people whose final days are carried out according to their wishes.
The term “advance directives” actually covers several types of documents, including:
A living will
This is a document that outlines your health care wishes when you’re unable to share them yourself. It goes into effect if you’re permanently unconscious or terminally ill, which a physician must confirm. Keep in mind that you can change or cancel your living will at any time.
Living wills can cover things like:
- Whether you want equipment such as dialysis or ventilators to keep you alive
- If you want doctors to resuscitate you if you aren’t breathing or your heartbeat stops
- If you want a feeding tube if you can’t eat or drink on your own
- If you want comfort care, such as medications for nausea or pain
- If you want to donate your organs or body tissue once you die
Durable power of attorney
Also known as a medical power of attorney, this is a document that gives another person, called a proxy, the legal right to make medical decisions for you if you can’t do it yourself. Before it goes into effect, a physician needs to certify that you can no longer make medical decisions on your own. You can also choose a backup person if your first choice isn’t able to do it.
Physician Orders for Life-Sustaining Treatment (POLST)
This form also details your health care wishes at the end of life, but it’s different than a living will. It includes specific medical orders for emergency situations that your doctor reviews and signs. It may cover things like whether to use CPR or whether to take you to the hospital, and it must be signed by a medical professional.
In general, emergency personnel are required to provide lifesaving treatments and cannot use a living will to guide their care. A POLST is meant to provide direction to emergency personnel if you DON’T want them to perform CPR or transport you to a hospital. Keep in mind that POLST documents only apply in some states. You can request forms at the national POLST website.
Do not resuscitate (DNR) orders
These orders direct medical staff not to revive you with CPR, AED, or breathing machines if your heart or breathing stops. This is also sometimes referred to as do not intubate (DNI). In the hospital, you can ask to add a DNR to your medical record, and you may need to add it each time you’re admitted. Outside the hospital, some states will allow you to carry a wallet card or bracelet with DNR orders. This is specifically intended for first responders, since they’re typically required to provide lifesaving care. Like a POLST, a DNR needs to be signed by a medical professional.
Organ and tissue donation
If you’d like to donate your organs or body tissue once you die, you can indicate this in your living will. Some states also allow you to include this information on your driver’s license.
How do you set up advance directives?
1. Think about your wishes and values.
Filling out the actual paperwork is just the final step in creating advance directives. The process starts with asking some tough questions about what you want to happen at the end of your life. For example, consider how important it is to you to be independent and self-sufficient, and identify what circumstances might prevent you from having the quality of life you desire. Would you want treatment to extend your life in any of these circumstances?
As you consider your choices, remember you can choose none, some, or all lifesaving treatments. Doing some real self-reflection can help you decide what you want. And while it might be scary at first, don’t let this daunt you—it’s a worthwhile exercise. There are plenty of resources online that can help get you started, including Five Wishes and the American Bar Association’s Tool Kit for Health Care Advance Planning.
2. Know the law.
All states have laws on the books about advance directives, which need to be in writing. State laws govern what is valid and what is not, so be sure to look into specifics for your state. Your state bar association may have forms you can fill out, or you can talk to an elder law or estate planning professional. It’s also important to talk to your health care team about relevant medical laws that might affect you.
3. Tell someone.
You’ll need to choose a person you trust to be your proxy or agent (i.e., the individual who will make decisions for you when you can’t). It’s important to be candid about your situation, wishes, and fears. On their own, advance directives may not be effective unless you’ve clearly communicated your wishes personally and empowered a loved one to help you carry them out.
Your proxy or agent should understand how you would make decisions if you were able, and they should be comfortable asking questions and advocating to your health care team on your behalf. While it’s normal to be nervous about a conversation like this, it’s also helpful to know that most people are open to this type of communication—in fact, 95% of Americans are willing to talk about their final wishes. Once you start the conversation, you’ll be glad you did.
Planning for peace
Figuring out how to establish your advance directives is much simpler when you know the steps involved—and that they exist to help you advocate for yourself and your final wishes. Making sure you have the right conversations, considering what you want, and having the right paperwork can give you and your loved ones comfort and confidence during a tough time.
Progressive Life by eFinancial is committed to helping protect families at every step. Final expense life insurance is specifically designed to cover end-of-life expenses and can provide crucial financial support in the wake of a death. We’re here to help you plan for the future in a way that lets you have peace of mind now.