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The Bones of Advanced Directives


Much has been made during the health-reform debate and town hall meetings about end-of-life care. While the end-of-life is a time most of us don’t wish to discuss, it is important to do so. It is important for your family and friends to know what you wish for yourself.

Plan for the end of life when you may not be able to speak for yourself. Let your family and friends know so they can speak for you. Then enjoy the health and life you have now.

The basic bones of advanced directives include a living will and a health-care proxy.

The living will explains to the healthcare team what kind of care you wish in various situations.

The health-care proxy or a health-care durable power of attorney allows someone of your choice to make decisions about your care when you no longer are able. This should be someone you trust to follow your wishes, even when it is difficult to do. This should be someone who knows what your wishes are. This means you have to discuss and talk about end-of-life issues while you are healthy.

An easy to use form for a living will, Five Wishes was introduced in 1997 and originally distributed with support from a grant by The Robert Wood Johnson Foundation. It is available in 23 languages. It doesn’t meet the legal requirements in every state, only in 40 of them, but regardless is a great platform for beginning the family discussion. It's available from www.agingwithdignity.org for $5 a copy.

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The Caring Connections Web site of the National Hospice and Palliative Care Organization has all 50 state forms available free at www.caringinfo.org/stateaddownload.

No living will is able to consider all possible scenarios which may occur at the end-of-life. They are guidelines of your wishes for your family and the healthcare team.

For example, what level of disability you'd be willing to live with and how to let you die if you had no hope of recovery. If, like my mother, you stroke out during heart surgery and your level of function is no speech, no self-feeding, no ability to walk or dance, would you want to be keep alive with a feeding tube and placed in a nursing home?

How much pain are you willing to endure so you can still communicate with those around you? Pain control may hasten death.

If you have been placed on a ventilator, but your recovery is not likely, do you want to remain on it or be removed from the ventilator?

These are just a few of the questions, the living will forms will help you discuss with family and friends. When you have filled it out, then it must be signed and witnessed. A few states will require a notarization. Make copies and give them to your family members and to whomever you chose to be your health-care proxy. It is also important to give a copy to your doctors.

Aging With Dignity (Five Wishes)