Discuss advance directives with family, healthcare providers now.
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I had a living will with an advance directive prepared about 10 years ago documenting my end-of-life medical wishes, but I have read that these documents are often ignored. If so, what can I do to avoid this issue?
Living wills are not always followed because the document is not available when needed or does not reach the appropriate medical providers in time. These documents can also fall short because they are not medical orders, and the language may be too general to guide healthcare providers during an emergency.
Fortunately, there are steps you can take to reduce the risk of confusion and help ensure your wishes are honored. Here are a few ways to make that happen.
About 40% of older Americans have an advance directive. This typically includes a living will that explains the care you want to receive if you become incapacitated and an agent appointed under a healthcare power of attorney (or proxy) who is authorized to make decisions on your behalf.
To strengthen those instructions, talk with your doctor about completing a POLST (Physician Orders for Life-Sustaining Treatment). A POLST may be called a MOLST (Medical Orders for Life-Sustaining Treatment) or POST (Physician Orders for Scope of Treatment), depending on your state. Unlike a living will, this is a doctor-signed medical order that must be followed by EMTs and hospital staff. It translates your wishes into clear instructions for treatments such as CPR, breathing machines and feeding tubes.
These types of interventions can save lives, but they may not be appropriate in every situation, particularly if you are very ill or frail. Discussing them ahead of time helps you weigh the trade-offs and makes it easier for your family to understand your choices, easing stress if decisions must be made quickly.
Even if you already have an advance directive, adding a POLST can help make your wishes clearer. Without one, first responders are generally required to attempt resuscitation and transport you to a hospital, where doctors may pursue aggressive treatment if your living will is unavailable or specific enough. Conversely, if you are planning to undergo surgery, you may want to temporarily suspend or modify your POLST because certain interventions may be appropriate to treat a temporary, reversible complication during the procedure.
Once your POLST is completed, make sure it is easy to find. Keep a copy of it on the refrigerator, in your wallet and on your phone. Share copies with your healthcare proxy, family members and physicians so everyone is on the same page.
It is also wise to ask your providers to add the form to your electronic health record, since medical information is not always shared between hospitals and care facilities. These steps can help ensure your wishes are followed.
If you have not yet established an advance directive, there are free templates or low-cost forms available online. Taking these steps now can help ensure your wishes will be followed and ease the burden on your loved ones later.
“Savvy Living” is written by Jim Miller, a regular contributor to NBC’s “Today Show.” The column, and others like it, is available to read via The American Legion’s Fund Development program, a way of establishing your legacy of support for the organization while providing for your current financial needs. Consider naming The American Legion in your will or trust as a part of your personal legacy. Learn more about the process, and the variety of charitable programs you can benefit, at legion.org/plannedgiving. Clicking on “Learn more” will bring up an “E-newsletter” button, where you can sign up for regular information.
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