The drive to get people from 18 to 78 to write living wills and evolve them as their lives do is being given new life.
“Advance care planning takes place over a lifetime. It changes as one’s goals and priorities in life change through different stages of life and health conditions,” asserts new guidelines on living wills from the American Bar Association Commission on Law and Aging.
As a rule of thumb, there are four stages of life that should trigger changes in living will development says Aging Commission Director Charlie Sabatino.
He says healthy young adults quite rightly think their chances of dying soon are small.
However, he points out many in their age range have accidents leading to temporary or permanent impairments where having someone named ahead of time to know and follow medical wishes is an a definite plus.
“My 30-something kids don’t want to talk about death and dying but they know they need a proxy,” says the legal expert cum dad.
Living will planning needs change considerably for those who acquire severe health threatening illnesses, Sabatino contends.
Diabetes and some heart conditions are not going to kill immediately, but a proxy should know how you want the illnesses managed and things that can go wrong,” he adds.
Another time for living will adjustments come when people are diagnoses with diseases which can kill.
At that time, the living will should contain directions on what life support technologies are acceptable and what medical personnel should do if things go wrong.
The final stage is when people are in hospice care.
The first step to creating a living will is to find someone you feel comfortable talking to who will know and carry out your wishes for end-of-life care as a proxy.
It’s harder than it sounds, cautions Sabatino.
Many people instinctively pick their spouse for the role.
But it’s a decision that requires more than an impulse he warns.
Sabitino says often a husband doesn’t want to go through the trauma of extended end-of-life care while a wife thinks everything should be done to save him for as long as humanly possible.
Also, he advised be careful not to choose a spouse or anyone else as a proxy who is so opinionated they could let their thinking override your wishes.
The guidelines are the outgrowth of a day-long conference the in March with 35 medical professionals and attorneys,
Sabitino says the guidelines were developed to put estate planning attorneys on the same page as doctors.
“Page” is the operative word.
“We’ve heard clinicians say if you give me a 10-page directive, I’m not going to read it,” says Sabatino.
He says doctors think of a living will as a life-time evolving process while many lawyers see it as a one-shot document to prepare.
The expert emphasizes a living will is not just a document.
Your directions for end-of-life care need to be reflections on your discussions with your doctor, your family and your attorney,” says Sabatino.
One of the biggest problems with living wills is it is often impossible for medical professionals and people with power of attorney to find they exist in the often immediacy they are needed for health care decision making.
To rectify the problem, a handful of states have created registries.
The Commission is developing a smart phone app that can give doctors and lawyers access to the sometimes many documents needed in a living will and to implement it.
The guidelines recommend in thinking about creating a living will, people should tell their attorney when they are or are not willing to bear through the following scenarios for a change of living longer:
- Being in a coma & not able to wake up or talk to loved ones.
- Not being able to live without being hooked up to machines.
- Not being able to recognize loved ones, as in the case of dementia.
- Not being able to feed, bathe, or take care of yourself.
- Not being able to live on your own.
None of the new Commission guidelines address financial issues of end-of-life care from health care costs to how much short to long intense medical treatment and hospice care can drain the resources a dying or disabled individual can leave to their loved ones.
“Nobody felt they needed a prompt for money. When people go to lawyer to have a living will drafted, they bring those concerns with them, says Sabatino.
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