In my last column, I focused on the first purpose of an Advance Health Care Directive, that of appointing an agent to make medical decisions for you when you are unable to make medical decisions for yourself. In this column I will focus on the second purpose of the Advance Health Care Directive: expressing your desires concerning the medical treatment you would prefer under certain medical circumstances.You may have heard of the term "living will." A living will is a written statement about the types of medical care you want (or don't want) if you become incapacitated. This is a different document than the "will" used for estate planning purposes. The living will is only concerned with health care issues, and does not deal with property. The Advance Health Care Directive incorporates the living will.
One of the most distressing situations a family has to face is that of making medical decisions concerning whether to withhold or withdraw life support for a loved one. I know of a situation in which brothers and sisters, holding vigil outside their mother's intensive care hospital room, spent hours heatedly arguing about what medical course of action to take rather than comforting one another. Since their mother had not expressed her wishes before she had a massive heart attack, the family was left to make the decision without the benefit of her input. Those voting to keep their mother on life support stated that they couldn't bear the guilt associated with "pulling the plug." Those voting to let their mother "pass on in peace" by disconnecting the life support felt it was the only humane thing to do under the circumstances. Without a consensus from the family, the doctor refused to take any action and mother languished in the hospital intensive care ward for a couple of difficult weeks before the inevitable occurred.
Most people I know are more concerned with quality of life and dying with dignity rather than length of days at any cost. There are legitimate concerns about living with debilitating pain, depleting resources, prolonging the anguish of loved ones, and an imbalance between the burdens of a proposed treatment versus the expected benefits. A common sentiment expressed in the Advance Health Care Directive is, "If I should have an incurable injury, disease, or illness certified by two (2) physicians to be a terminal condition, and if the application of life-sustaining procedures would serve only to artificially prolong the moment of my death, and if my treating physician determines that my death is imminent, whether or not life-sustaining procedures are utilized, then I desire that all life-sustaining treatment be withheld or removed." The Advance Health Care Directive can also set forth preferences concerning medical conditions such as coma and Alzheimer's, and whether organ donation and autopsy are permissible.
When an estate plan is prepared, a discussion and statement of preferences regarding end-of-life issues must be an integral part. Just like the disposition of your worldly goods, decisions involving your health care should be carefully considered and clearly stated during the estate planning process. © 2009 by Marlene S. Cooper. All rights reserved.