How We Want to Die

Advance health care planning is not just for the elderly. “You just never know when something’s going to happen to you that would make it impossible for you to make your own healthcare decisions,” says Timothy L. Takacs, Certified Elder Law attorney and founder of Elder Law Practice of Timothy L. Takacs in Hendersonville. “Terry Schaivo and Karen Quinlan were both in comas for years. It’s no surprise that these young women hadn’t appointed anyone to make healthcare decisions for them. They never expected to be incapacitated.”

These high-profile cases underscore the unpredictability of life and drive home the need to identify someone to be the decision-maker if you’re unable to make decisions for yourself. 

Where do you start? 

The steps are the same for everyone, young and old, counsels Takacs. The easiest place to start is to think about whom you would trust to make healthcare decisions on your behalf if you were incapacitated in an accident or sidelined by an unexpected illness. The legal term for this decision maker is a Healthcare Agent. “Your Healthcare Agent can be anyone you trust—a spouse, a child, sibling or someone else,” said Takacs. “The most important thing is to choose someone with shared experiences and similar values who would stand up and advocate for you in the way you would want.” 

Taking time to think through possible choices is a good idea before approaching anyone with a request. “The biggest stumbling block to any conversation is the 'what-ifs' that will inevitably arise,” said Takacs. “That’s why it’s a good idea to think about various scenarios and start writing those down. What kind of medical intervention would you want if your life were on the line? What treatments would you want to avoid? Thinking out loud in a journal or notebook is a good way to clarify your thoughts until you can work up to a conversation with the person you’ve chosen.”

Once you’ve selected your Healthcare Agent, the next step is to draft a Healthcare Power of Attorney, which legally designates the person you choose to make healthcare decisions on your behalf. “The Healthcare Power of Attorney is situational in nature, meaning that it only goes into effect during times of incapacity,” says Takacs, who stressed the importance of drafting documents before a person is unable to make their own decisions. “It’s especially important that Healthcare Powers of Attorney for elderly loved ones are created while they still have their full mental faculties.” State laws vary on the exact criteria for creating a Healthcare Power of Attorney and it is always a good idea to consult an attorney to ensure the document is drafted properly. 

Creating an Advance Directive usually follows. Also known as a Living Will, an Advance Directive allows a person to choose the type of care received at the end of life. When the patient's wishes are in writing, they can't be overridden by the Healthcare Agent or by other family members. “Without an Advance Directive, a person could be subject to unwanted medical interventions,” said Takacs. “For example, a person might be resuscitated when he doesn’t want to be. Or he could be kept alive with a ventilator and tube-fed when his preference would be to forego life support.” 

Though Advance Directives are generally easy to create and it’s possible to create them online, the process can be intimidating. “The State of Tennessee has a ten-page Advance Directive document that asks you to speculate about how you would want to be cared for,” said Takacs. “It lays out several situations and asks what kinds of treatments you would prefer. The 'if-then' scenarios can be extremely stressful for families to think about.”

The Physician’s Order for Scope of Treatment (also known as the POST form) is another type of Advance Directive used by health care professionals working with residents in long-term care facilities such as nursing homes or assisted living centers. The POST form allows the doctor to have a conversation with an individual or his or her legal representative about desired medical treatment and then translate those wishes into doctors’ orders for use by hands-on caregivers such as nurses and EMTs in the facility. See an example of a POST form here. 

Ultimately, everyone needs a Healthcare Power of Attorney and an Advance Directive. “Few things in life are more daunting than thinking about what might happen to you if you have an accident, illness or injury,” says Takacs. “Taking a few moments to think about this might be the very thing that gives you some measure of control over the way your life comes to an end. It’s also a wonderful gift to family members who won’t have to guess at what you might have wanted.”~

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