Advance Health Care Directives
An Advance Directive [aka Advance Health Care Directive, Living Will, Personal Directive, or Advance Decision in different jurisdictions] is a set of instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity and appoints a person to make such decisions on their behalf. A Living Will is one form of advance directive, leaving instructions for treatment. Another form authorizes a specific type of power of attorney or health care proxy, where someone is appointed by the individual to make decisions on their behalf when they are incapacitated. People may also have a combination of both.
Advance directives were created in response to increasing medical technology. Studies have documented critical deficits in the medical care of the dying. You may remember the cases of Karen Ann Quinlan [New Jersey Supreme Court, 1976] or Terri Schiavo [Florida Second District Court of Appeal four times, 2001-2003, Florida Supreme Court, 2004 and U. S. Supreme Court, 2004]. Dying can become unnecessarily prolonged, painful, expensive and emotionally burdensome to both patients and their families. Aggressive medical intervention leaves nearly two million Americans confined to nursing homes, and over 1.4 million Americans remain so frail as to survive only through the use of feeding tubes. As many as 30,000 persons are kept alive in comatose and permanently vegetative states.
Cost burdens to individuals and families are considerable. As more and more Americans experienced the burdens and diminishing benefits of invasive and aggressive medical treatment in poor prognosis states – either directly (themselves) or through a loved one – pressure began to mount to devise ways to avoid the suffering and costs associated with treatments one did not want in personally untenable situations. The first formal response was the Living Will.
On July 28, 2009, Barack Obama became the first United States President to announce publicly that he had a living will and to encourage others to do the same. He told an AARP town meeting, “So I actually think it’s a good idea to have a living will. I’d encourage everybody to get one. I have one; Michelle has one. And we hope we don’t have to use it for a long time, but I think it’s something that is sensible.” The fact is simply that it is sensible. You do not want to put your spouse or child in the position of having to make a decision like this alone. Provide the input needed and take the burden and guilt from them by telling them in advance, “Hey, this is what I choose…”
In California, we use Advance Directives, though many still call it a Living Will. These documents are a snapshot, a moment in time, and may therefore need regular updating to ensure that the correct course of action can be chosen. After time, you may decide your child is old enough or mature enough to handle being an Agent, OR the Agent you chose may die OR you have changed your mind about an appointed Agent. Keeping this current is critical.
Give this some serious thought. When you are ready to have one drafted, please give me a call. I am here to help.