When creating your living will and your durable power of attorney (POA) for health care, you have many options and a great deal of flexibility. Following are some issues you may want to consider. (For basic information about these two documents, see The Living Will and Power of Attorney for Health Care: An Overview.) Note that in some states, living wills and POAs for health care are two separate documents, while in others, they are combined into one, usually called an advance health care directive. These health care documents also go by different names, depending on your state.
Your living will (also called a health care declaration in some states) is where to write out what you do and do not want in terms of medical care. These are directions for your loved ones and doctors to use if you are ever unable to speak for yourself. You don't need to become a medical expert to complete your document, but it will help you to become familiar with the kinds of medical procedures that are commonly administered to patients who are seriously ill.
In most states, living wills ask you whether or not you want to receive life-prolonging treatments at the end of life. Such procedures typically include:
If you want more information, you can discuss these treatments with your doctor or a patient representative at a hospital or health insurance plan office, or you can turn to self-help resources for more detailed information. (See How to Write a Living Will.)
If you are close to death from a serious illness or are permanently comatose, you may not be able to survive without the administration of food and water. Unless you indicate that treatment should be withheld, doctors will use intravenous (IV) feeding or tubes to provide you with a mix of nutrients and fluids. IV feeding, where fluids are introduced through a vein in an arm or a leg, is a short-term procedure. Tube feeding, however, can be carried on indefinitely.
Permanently unconscious patients can sometimes live for years with artificial feeding and hydration without regaining consciousness. If food and water are removed, death will occur in a relatively short time due to dehydration, rather than starvation. Such a course of action generally includes a plan of medication to keep the patient comfortable.
When you make your health care documents, you can choose whether you want artificially administered food and water withheld or provided. This decision is difficult for many people. Keep in mind that as long as you are able to communicate your wishes, by whatever means, you will not be denied food and water if you want it.
If you want death to occur naturally—without life-prolonging intervention—it does not mean you must give up treatment to alleviate pain or keep you comfortable. This type of care, sometimes known as "comfort care," is now more commonly called "palliative care."
Rather than focusing on a cure or prolonging life, palliative care emphasizes quality of life and dignity by helping a patient remain comfortable and free from pain until life ends naturally. Palliative care may be administered at home, in a hospice facility, or at a hospital.
You may wish to spend some time educating yourself about palliative care. You can include your feelings and preferences about such care in your living will.
Some people who do not wish to receive life-prolonging treatment when close to death—most likely those who are already critically ill—may also want to prepare a "do not resuscitate" order, or DNR order. If a medical emergency occurs, this form alerts emergency personnel that you do not wish to receive cardiopulmonary resuscitation (CPR).
If you are in the hospital, your doctor can add a DNR order to your medical record. If you are not hospitalized, you can make what's called a "prehospital DNR order," to alert paramedics who come to your home or care facility. In addition to preparing a prehospital DNR order and keeping it nearby, you can also obtain an easily identifiable medical alert bracelet, anklet, or necklace.
In an increasing number of states, DNR orders are being included in or replaced by a broader set of medical orders called Physicians Orders for Life-Sustaining Treatment forms (POLST forms) or something similar. In addition to instructions about CPR, POLST forms include directions to health care providers about other life-prolonging treatments, such as intubation, antibiotic use, or feeding tubes. While a POLST covers more medical situations than a DNR order, it is still intended for use in emergency situations, and is not a substitute for a more thorough advance health care directive or living will and medical power of attorney. (To learn more about POLSTs, including how they are used and what they are called in your state, see About Physicians Orders for Life-Sustaining Treatment (POLST) Forms.)
If you think you might want to make a DNR order or POLST form, talk to your doctor or a hospital representative.
You can use a durable power of attorney for health care to name someone (your health care agent) to oversee your health care wishes and make any necessary medical decisions for you. You can give your health care agent as much or as little power as feels comfortable to you. Most people give their health care agent comprehensive power to supervise their care.
Recognizing this, the power of attorney forms for most states give your agent the authority to make all health care decisions for you unless you specifically place limits on that authority in the document. This means that your agent will normally be permitted to:
Most of your agent's authority under a durable power of attorney for health care will end upon your death. In many states, however, you can give your agent permission to oversee the disposition of your body, including authorizing an autopsy or carrying out your wishes for organ donation. If you want your agent to have these powers, you should say so in your health care POA.
If you have specific wishes about these matters, your living will is a good place to write them down. Your agent is legally required to follow your instructions whenever possible. (For more information, see How to Become an Organ Donor.)
Keep in mind that as long as you are able to understand and communicate your own wishes, your agent cannot override what you want. Your agent steps in only if you can no longer manage on your own.
In addition, as mentioned, you are permitted to restrict your agent's authority in any way that you like. For example, some people give their health care agent only the authority to carry out the health care wishes specified in their living will, and not to make other medical decisions for them.
Think carefully, however, before you add limiting language to your power of attorney. One of the most important reasons for appointing a health care agent is so that someone will be there to respond to the needs of your situation as it develops. Your medical needs may change in ways that you didn't anticipate, and an agent who has full power can act for you no matter what the circumstances.
If you need help picking the right person to oversee your medical care, see Choosing Your Health Care Agent.
For more information on health care documents, visit our Living Wills & Medical Powers of Attorney section.