Planning for Peace of Mind

Leonard D. Reeves, M.D., knows firsthand how important it is to have a plan in place so your loved ones can make decisions for you if you can’t.

“I lost my wife about six years ago. She was not old — she was 53 — but she had liver failure,” he says. “We had talked about what she wanted. She did not want to be put on any mechanical assistance. So we were able to do what she wished, and it was so much easier when we gathered the family to know that this was her wish, and not necessarily any one of us wanting our wish imposed on her.”

Reeves, a member of the board of directors of the American Academy of Family Physicians, encourages his own patients to share their wishes with their loved ones and to get the proper paperwork in place so the loved ones can voice those wishes in case of illness or death. It’s not always easy to talk about, but it’s important.

Would you want life support in the form of a feeding tube or ventilator? Or would you prefer to die a natural death? “Talk with family members and let them know what you want and what you don’t want,” Reeves says.

The Case for Being Prepared


And before you say, “But I’m young and healthy,” know this: It’s important to have these conversations before you’re sick or injured. “People think if they’re not sick, they don’t need this, but these plans come into play when you are unconscious or unable to understand or communicate,” says Elizabeth Revenko, a certified financial planner and a member of the Financial Planning Association. “This gives you the chance to say what you want, not to have someone else make these decisions for you.”

Perhaps most crucial, having these conversations in advance makes it less likely there will be a situation later that pits family members against one other. Reeves has seen fights break out among family members over medical decisions, such as whether to use a ventilator or a feeding tube. “I’ve seen it really tear up families,” he says.

Edo Banach, president and CEO of the National Hospice and Palliative Care Organization, points to headline-grabbing cases. Karen Ann Quinlan was a 21-year-old who became comatose in 1975. Her parents wanted to end her life support, but the hospital objected. Terri Schiavo spent 10 years in a vegetative state and on a feeding tube. Her husband wanted to end life support; her family did not. Quinlan’s parents and Schiavo’s husband prevailed after lengthy court battles.

“The last thing we want are stories like these — unfortunate situations where someone’s wishes are not that clear and family members end up fighting,” Banach says.

Planning — completing “advance directives” such as a health care power of attorney and a living will — can seem overwhelming. Here are answers to questions that might help.

Q: Where do I start?


A. Begin with a conversation with your primary care physician. He or she can explain the types of interventions that medical professionals can provide, such as CPR, feeding tubes, respirators and pain management, and outline the options to consider when deciding which you might want. Your doctor can also help you decide who should make medical decisions on your behalf.

To make it official, you fill out legal forms, which you can do with or without a lawyer (though some forms need to be witnessed or notarized). Some states have their own forms; contact your local Area Agency on Aging if you need help accessing them. Your key choices fall into two areas: who can make health care decisions for you if you can’t; and how you would like those decisions to be made.

Q: Who makes decisions for me?


A: Your health care power of attorney is a document that names the person you want to make decisions for you. You should choose a family member or a close friend, not your doctor. And make sure you also choose an alternate, in case both you and the person you’ve selected are unable to make decisions.

Be sure to ask the person before you name him or her in the document. It shouldn’t come as a surprise that he or she might have to make health care decisions for you. Be aware that this health care power of attorney does not give someone the right to make decisions that you could make yourself. “You have to lose your own ability to make decisions” for that person to be in charge, Reeves says.

While life-care planning is often linked with end-of-life issues, it also comes into play in other situations. Suppose you have dementia and can no longer decide whether you should be admitted to an assisted living facility. In some states, no one can make that decision for you without going through the process of getting guardianship. “You’re in a tricky position,” Banach says. “There’s no one to consent to care.” If you have a life-care plan in place, however, the person you’ve named in your health care power of attorney can decide for you.

Q: What if I don’t designate a decision maker?


A: You don’t have to choose someone to make decisions for you. In that case, if you’re unable to make medical decisions for yourself, your state likely has a plan in place — called a “natural order of priority” — that outlines who is called upon.

But that outcome can be undesirable for two reasons: The person named to make decisions for you might not be the person you would choose, and that person might be forced to make difficult decisions quickly without knowing what you would want.

Q: How should my wishes be carried out?


A. Your living will outlines the type of care you would like if you couldn’t make decisions on your own. “It’s about making sure you’re given a voice to talk when you can no longer use your own,” Banach says. Your doctor can help you decide what to include.

Think about medical interventions you would or would not want in case of serious or life-threatening illness. People typically consider whether they would want CPR, a ventilator or a feeding tube. You may want to indicate whether you want to donate your organs after death as well.

Once you’ve completed your living will, review it with the people you have named to make health care decisions for you. The more information you can give them about what you want, the better. It can ease their struggles if they know what you would want them to do.

It’s a good idea to review these documents as part of your regular wellness checkup. “Health care can change in any direction as you experience ill health,” Revenko says. You might think you would never want a certain type of care but then change your mind. Or you might decide you’re done with certain types of treatments.

Q: What if the worst happens?


It’s not enough to have a plan. Make sure your doctor and loved ones can access your documents. “Without the forms, there’s no guarantee your wishes are going to be followed,” Banach says.

Don’t just put them in a safe deposit box. Keep a copy and give copies to the person you’ve chosen to speak for you and to your doctor. Your doctor’s electronic copy should be available to hospitals and other doctors who are caring for you. Some states and organizations provide a brightly colored paper you can stick to your fridge, so if you need emergency care at home, medical personnel can see your wishes.

“You want as many folks and institutions as possible to have it,” Banach says, “so there are no questions about what your wishes are.”

Research advance care planning and learn how to make important decisions that affect your life.