It is difficult and can be uncomfortable to talk to your loved one to plan for the end of their life. This isn’t something that anyone wants to think about, but discussing your loved one’s wishes with them now—before there’s a medical crisis—and getting all the necessary documents in order, helps ensure that your loved one will get the medical care they want if they become unable to communicate their wishes.
An advance directive refers to any legal document regarding your health care preferences. It only goes into effect when a patient is incapacitated and unable to speak for themself—some examples are if they had a stroke, were in a coma, had dementia, or were under anesthesia. Having such documentation can bring relief to family members. Having your loved one’s wishes in writing keeps you from wondering if you “did the right thing” regarding their health care. It can also bring some peace to your loved one to know that their wishes will be respected.
Living Will
The most common type of advance directive is a living will. This is a legal document that states your loved one’s future health care wishes if they become unable to do so themself. Before a living will is used to direct medical decisions regarding treatment, two physicians need to confirm that the patient is unable to make their own medical decisions and is in a medical condition specified as a terminal illness or permanent unconsciousness—which varies by state.1
A living will specifies their end-of-life wishes—including their wish to donate their organs, if appropriate—and is used when they are terminally ill, permanently unconscious, or unable to communicate. Specifically, it includes what types of life-prolonging treatment your loved one would or would not want to receive under those circumstances—such as a feeding tube or life support.
A living will also indicates if your loved one wants a Do Not Resuscitate Order (DNR). A DNR is an order given by a physician after they have determined your loved one has an end-state medical condition or are permanently unconscious, that CPR or other life support measures not be performed if their heart stops or they stop breathing. A DNR is sometimes referred to as a DNAR (do not attempt resuscitation) or an AND (allow natural death). A DNI—or do not intubate—order instructs medical personnel that your loved one does not want to be put on a ventilator.
A living will is not the same as refusing all medical care. Even if your loved one is incapacitated, they could still receive palliative care such as pain medication or antibiotics. The goal of treatment changes to comfort instead of attempts to cure.
MOLST and POLST
This can be another part of your loved one’s advance directive. MOLST is the Medical Orders for Life-Sustaining Treatment. In some states, this is called POLST or Physicians Orders for Life-Sustaining Treatment. This is a set of medical orders that must be based on your loved one’s current health status and current prognosis. These orders define the life-sustaining treatment they want to receive now, unlike a living will which is for treatment in the future. Another difference between MOLST and a living will is that MOLST is a form completed and signed by the patient, while a living will is a legal document. Once the form is completed and counter-signed signed by a physician, MOLST goes into effect immediately and must be honored by all health care professionals in all settings.
MOLST is not appropriate if your loved one is healthy or has a chronic condition with a long life expectancy. Having living will is more appropriate in this case. MOLST or POLST should be considered in cases of terminal diagnoses.
Healthcare Power of Attorney
A healthcare power of attorney (HCPA) is a legal document allowing your loved one to empower someone they trust to make decisions about their medical care if they are unable to communicate. The people named in the HCPA become healthcare proxies and can communicate with your loved one’s doctors regarding treatment. The HCPA becomes active as soon as they become incapacitated.
Writing an HCPA requires filling out a form and having it notarized. The healthcare proxy can be changed or revoked at any time by completing a new HCPA form.
Financial Power of Attorney
A financial power of attorney, also known as a general power of attorney (POA), operates like the HCPA but allows your loved one to empower someone they trust to make decisions about their finances and property. In most cases, they would have a POA if they were ill or physically not available or able to sign important paperwork. The person with the financial power of attorney can be a different person than the person with the healthcare power of attorney.
A financial power of attorney automatically ends when the person who issued it dies. This means that the person granted POA’s ability to make financial decisions ends as well. Financial decisions after the person’s passing are made by the executor or personal representative who has been named in their will.
Last Will and Testament
A last will and testament is a legal document that specifies your loved one’s final wishes regarding their assets and dependents. It outlines what they wish to be done with their belongings and other things for which they are responsible—such as custody of any dependents, property, and management of accounts and financial interests.
A will designates someone to be the executor of the estate. That person is responsible for administering the estate. The probate court usually oversees the executor to ensure that the wishes detailed in the will are carried out.
For more detailed information on advanced care planning and specific resources to help you with each step, visit the National Institute on Aging’s “Getting Your Affairs in Order”. References 1 American Cancer Society, Types of Advance Directives. https://www.cancer.org/treatment/treatments-and-side-effects/planning-managing/advance-directives/types-of-advance-health-care-directives.html