End of Life Care
Just a couple of generations back, lives could not be extended with the help of feeding tubes, ventilators, dialysis pumps, or cardiac defibrillators. There was little chance of prolonging the inevitable and death was acceptable. In the past 50 years, however, medical technology has made it possible to extend lives — and also to prolong the dying process.
In 1976, the parents of a woman in a vegetative state won a long legal battle to disconnect her from respiratory support. The incident spurred the public’s interest in “advance directives” — documents that allow you to designate under what conditions you would want life-sustaining treatment to be used. According to a recent article in Modern Maturity (September-October 2000), 75% of Americans are in favor of advance directives, but only 30 – 35% actually write them. It’s not, however, particularly difficult to do.
There are two kinds of advance directives, and you can use one or both. Without an advance directive, a hospital staff is legally bound to do everything possible to keep you alive, unless you or a family member objects. A Living Will details what kind of life-sustaining treatment you want or don’t want during a terminal illness. But most experts consider a Living Will insufficient because you cannot predict exactly what situation you may someday be in.
Creating a power of attorney document or health care proxy appoints someone to make decisions for you should you be become incapacitated. This document is considered much more important than the Living Will, since all the current and available options can be evaluated by someone you trust to make decisions consistent with your wishes.
To make an advance directive (a good time is when you make or revise your will), you can use existing booklets and questionnaires, such as those found at the American Association of Retired Persons Web Site. You should also discuss your wishes with your family physician. When you name a power of attorney, you should make sure that person agrees to act for you and understands your wishes. (Forms also need to be notarized or witnessed by two people unrelated to you.)
Finally, make sure these documents are readily available to others. An estimated 35% advanced directives cannot be found when needed. Give a copy to your proxy, doctor, hospital, and family members, and tell them where the original is kept (don’t keep it in your safe deposit box). You may register your Living Will and power of attorney at www.uslivingwillregistry.com. This free service will fax a copy to your hospital upon request and will remind you to update the Living Will.
Planning ahead is important — especially in light of the fact that only 10% of people die suddenly. Although death is usually a slow decline, with advance planning you can have some say in the kind of physical and emotional care you receive in your final days.
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