A living will is a document in which you can write down in advance
your wishes regarding life-sustaining treatments should you become
terminally ill and unable to convey your decisions to your physician. For
example, in a living will you can direct that, should you become
terminally ill and mentally incapacitated, you do not want to be kept
alive on a respirator. You can also enumerate the circumstances in which
you wish to receive life- sustaining treatments. Thus, you could direct in
a living will, that should you become incapacitated, you want to be kept
alive by artificial nutrition and hydration. Directions in living wills
will not be followed as long you are capable of making your own treatment
decisions. In addition, the creation of a living will is entirely
voluntary, and therefore no one can require you to do so.
Are living wills recognized in every state?
Laws authorizing living wills have been enacted in over 40 states.
However, these laws can vary in important ways. For example, according to
some state laws, instructions in living wills must be followed only when
individuals are suffering from a disease that will shortly lead to their
deaths, regardless of medical interventions. Other states’ laws provide
that living will instructions are effective even if a person is in an
irreversible coma that will not cause the person’s death. In some
states, individuals may write living wills at any time while in others,
individuals may not write living wills once they have acquired a terminal
illness. Some states recognize living wills for specific periods of time,
for example five years, while other states place no time limits on the
effectiveness of living wills. Significantly, some states will not legally
acknowledge instructions in living wills that direct the removal of
feeding tubes that provide nutrition and hydration.
disadvantages of living wills
Using a living will allows you to specify the circumstances under which
you wish to receive particular types of life-sustaining treatment. Thus,
living wills can give you some control over your medical care when life
and death decisions need to be made. However, living wills are ordinarily
not used to delineate treatment decisions you would wish put into effect
in the event you were to suffer from a nonterminal illness and lose your
ability to make treatment decisions. For example, if you were to become
unconscious as a result of a non-life-threatening fall, the instructions
in your living will would usually be irrelevant. In addition, even in a
terminal illness context, it is impossible to anticipate in a living will
all of the possible treatment choices with which you might be faced. Thus,
regardless of how detailed you make your living will, there still may
arise unexpected circumstances not covered by it. Another difficulty with
using living wills is that conflicts can arise over its proper
interpretation when treatment decisions need to be made.
Health Care Proxies
Most states have laws that permit you to appoint a
health care agent to make medical decisions for you should you become
unable to make such decisions yourself. The appointment of these health
care agents is most often accomplished through the filling out of forms
known as health care proxies. Some health care proxy forms allow you to
direct your agent to make specific medical treatment decisions in
State laws generally grant health care agents the power
to make all medical decisions for incapacitated persons, including
decisions concerning life-sustaining medical interventions. For example,
if a man appoints his wife as his health-care agent and then becomes
incompetent due to Alzheimer disease, the wife is empowered to decide his
course of treatment Some states, however, restrict the ability of health
care agents to make decisions about the insertion or removal of feeding
tubes that provide patients with nutrition and hydration. Regardless of
the scope of their powers, health care agents have no authority to make
any medical decisions for you before it’s been determined that you
cannot make the decisions for yourself. The health care proxy laws
generally permit you to list alternate health care agents so that someone
will be able make medical decisions for you should your original proxy be
unavailable. Like the living will, the appointment of a health care agent
is entirely voluntary.
Who should you appoint as your health
Generally, you can appoint any adult to be your health
care agent, although you should first determine whether that person is
willing to serve as your agent. People who appoint health care agents
generally choose someone who knows them well, cares about them, and whom
they can trust. For example, some people appoint spouses or other close
family members as their proxies, while others appoint close friends.
Regardless of who you appoint as your health-care
agent, it is a good idea for you discuss with him or her medical treatment
issues that are important to you. An example of such an issue is the use
of artificial nutrition and hydration should you become incompetent and
have little chance of regaining your mental faculties. By discussing these
issues with your health-care agent, the agent will be more likely to have
the information necessary to determine the types of medical decisions you
would want made for you should you become incapacitated. Even if you do
not discuss these issues with your agent, your agent will still have the
power to make medical decisions for you if you are unable to do so
Differences Between Living Wills and Health Care Proxies
As opposed to living wills, health care proxy forms do
not require you to specify what treatments you would wish to undergo in
particular circumstances. Rather, they permit you to appoint an agent who
is empowered to make virtually any health care decision for you should you
lose decision-making capacity. In addition, while living wills generally
cover only decisions about life-sustaining treatments in circumstances
where an incapacitated individual has a terminal illness or is in an
irreversible coma, health care agents may make medical decisions in all
circumstances in which an individual becomes incapacitated. In many ways,
therefore, the appointment of a health care agent allows for greater
flexibility than does the writing of a living will.
and How to Write a Living Will and Fill Out Health Care Proxy Forms
Many people associate health care proxy forms and
living wills with the elderly or very ill. However, some of the most
prominent cases that illustrate the need for these documents involved
young adults in tragic accidents who became incapacitated and required
decisions to be made for them about life-sustaining treatments. Because
the occurrence of serious injuries or sudden changes in health status
cannot be predicted with any certainty, it is a good idea for you to fill
out one or both of these documents as soon as you are able no matter what
your age or health status.
Some state departments of health and nonprofit
organizations such as Choice in Dying can provide you with detailed,
state-specific information about health care proxies and living wills.
Hospitals and other medical providers that receive federal funds are
required by federal law to provide you, upon your admission as a patient,
with information about your rights under state law to create advance
directives such as living wills and health care proxies.
After you have written a living will or have filled out
a health care proxy form you should let your family and close friends know
about its existence and location, so that they can readily access the
document should the need arise.
Living wills and health care proxies are advance
directives that allow you to retain control over your medical care if you
become incapacitated and are no longer able to make medical decisions for
yourself. In a living will, you are able to specify circumstances under
which you wish to be given particular life-sustaining treatments, while
health care proxies enable you to appoint an agent to make medical
decisions for you. Regardless of your age or state of health, these are
important documents to have.
© 2000 Healthology, Inc.
What is long-term care?
Most Americans know about the kind of health insurance that
pays doctor and hospital bills. But the kind that pays for
long-term care in a nursing home or at home is not as familiar.
Long-term care goes beyond medical care and nursing care to
include all the assistance you could need if you ever have a
chronic illness or disability that leaves you unable to care for
yourself for an extended period of time. You can receive
long-term care in a nursing home, or in your own home, in the
form of help with such activities as bathing or dressing.
Long-term care can be of help to a young or middle-aged person
who has been in an accident or suffered a debilitating illness.
But most long-term care services are used by older people.
Beyond nursing homes, there is a range of services available
in the community to help meet long-term care needs. Care given
by family members can be supplemented by visiting nurses, home
health aides, friendly visitor programs, home-delivered meals,
chore services, adult daycare
centers, and respite services for
caregivers who need a break from daily responsibilities.
These services are becoming more widely available. Some or
all of them may be found in your community. Your local Area
Agency on Aging or Office on Aging can help you locate the
services you need. Call the Elder care Locator at 800-677-1116
to identify your local office.
Are you likely to need long-term care?
This year about seven million men and women over the age of
65 will need long-term care. By the year 2005, the number will
increase to nine million. By the year 2020, 12 million older
Americans will need long-term care. Most will be cared for at
home; family members and friends are the sole caregivers for 70
percent of elderly people. But a study by the U.S. Department of
Health and Human Services indicates that people of age 65 face
at least a 40 percent lifetime risk of entering a nursing home.
About 10 percent will stay there five years or longer.
The American population is growing older, and the group over
age 85 is now the fastest-growing segment of the population. The
odds of entering a nursing home, and staying for longer periods,
increase with age. In fact, statistics show that at any given
time, 22 percent of those age 85 and older are in a nursing
home. Because women generally outlive men by several years, they
face a 50 percent greater likelihood than men of entering a
nursing home after age 65.
You may never need a nursing home. But the longer you live,
the greater the chance that you will need some form of long-term
© 2000 Health Insurance Association of America
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