End-of-Life Medical Decisions
When creating your estate plan, you must consider the possibility that you will become unable to make our own medical decisions, due to terminal illness, or permanent unconsciousness. Medical science continues to advance, keeping people alive much longer than before, sometimes indefinitely. In order to protect your family from the kind of heart-wrenching decisions and acrimony we have seen in the many well-publicized "right to die" cases, you can give detailed instructions regarding the kind of care you want should you become terminally ill or permanently unconscious. These instructions are called advance directives. In Connecticut, advance directives take the form of an Appointment of Health Care Representative and a Living Will.
Appointment of Health Care Representative
If your physician determines that you are incapacitated and unable to communicate your wishes concerning treatment, it is important that someone have the legal authority to communicate your wishes for you. An Appointment of Health Care Representative allows you to appoint someone to act as your agent for medical decisions. By executing an Appointment of Health Care Representative, you ensure that your wishes will be carried out by your representative even if your family members disagree with them. It also takes the burden of decision making away from the rest of your family. If you later become able to express your own wishes, you will again make your own health care decisions and the health care appointment will have no effect.
Since your representative will have the authority to make medical decisions for you, he or she should be a family member or friend that you trust to follow your instructions. Before making an appointment, talk to the person first about your wishes concerning medical decisions, especially life-sustaining treatment, and make sure they are up to the task.
You also need to ensure that your representative has access to necessary medical information in order to make decisions for you. Under the privacy rules of the Health Insurance Portability and Accountability Act (HIPAA), doctors, hospitals and other health care providers are no longer permitted to freely discuss your status or health with your spouse or other family members unless they have a signed consent form from you in hand. Your Appointment of Health Care Representative should refer specifically to HIPAA.
Living Will
A Living Will is a document that states your wishes regarding the kind of health care you want if you become terminally ill or permanently unconscious. Your Living Will can tell your physician whether you want artificial respiration, cardiopulmonary resuscitation (CPR), artificial means of providing nutrition and hydration, kidney dialysis, and antibiotics (other than for my comfort) to keep you alive. It becomes operative when your physician determines that you are incapacitated - unable to make or communicate your decisions about your medical care. It is especially important to have a Living Will if you want to avoid life-sustaining treatment when it would be hopeless. You can always revoke it at a later date if you wish.
Your Living Will may contain very specific directions to refuse or remove life support in the event you are terminally ill or permanently unconscious, or may provide instructions to use all efforts to keep you alive no matter what the circumstances. Some people only want life support removed after a certain period of time (e.g. - 14 days after the diagnosis of terminal illness). Others may wish to be moved to a state like Vermont or Oregon that allow residents with terminal disease the option to be prescribed a dose of medication to hasten the end of their life. Such wishes are expressed in your Living Will.
POLST (Physicians Orders for Life Sustaining Treatment): A New Approach
Because advance directives have not been consistently followed, especially in circumstances where serious terminal illnesses require more explicit instructions to health care professionals, an alternative has emerged in recent years called the Physician Orders for Life-Sustaining Treatment (POLST), sometimes called Medical Orders for Life-Sustaining Treatment (MOLST). The POLST uses a standardized medical order form that the physician reviews with a seriously ill patient to indicate which types of life-sustaining treatment the patient wants or doesn't want if his or her condition worsens. Legislation to implement POLST in Connecticut is being developed in the General Assembly and will be the subject of a future post.
To protect your family from needless anguish and complications, make sure you consider end-of-life care decision making. Include advance directives in your estate plan.
