What Now?

Now that we have the living will and/or health care proxy, filled out, witnessed and signed, what do we do with it?

First of all, make several copies and keep the original. Make sure that your designate gets a copy, and your family physician. If you need to be hospitalized you will be asked if you have one, and you may need to provide them with a copy. You may need to give a copy to a specialist that you are consulting with.

Do not store your original away in a safety deposit box. The document needs to be accessible in case of need. Your spouse/partner or designate should know of its location.

It is also wise to keep a laminated card in your wallet stating that you have a living will/health care proxy in force along with the name of your designate. And if you haven't already, make your family members aware that you have a health directive filled out.

Further down in the blog I have mentioned 'Five Wishes', which is a good document to look at and would serve well as both your living will and health care proxy as it covers both and poses issues that you might not think of. It is what I use, is legal in most states. If nothing else a good look at it might serve as a start in finding the documents that work best for you.

Legal Document/Legal Signatures

Now that we have chosen our designate, had those open conversations about our final wishes, found the forms that most meet our needs, filled them out... What's next?

It is a trivial thing, but making sure that the living will or health care directive that we choose is legal in the state that we reside in is imperative. And also it should be legal in the state/s that we vacation/winter/summer in. And maybe even those states that we might travel through to get to our vacation destination/seasonal home. It might not be an issue at the moment, but there may come a time when we decide to spend an extended period of time closer to our families, or maybe away from the snow and ice for a season. Taking care to cover our options at the beginning could make things easier later on.

Seems a bit ridiculous, but what my recommendation is for us to make the extra effort to have the signatures meet our local requirements, and beyond. In some states it is perfectly acceptable to have our spouse sign the form as a witness, or as one of the witnesses. In some states it can't be a spouse. And in some, not even a relative or our designate. And in some states the witness signatures need to be "notarized".

So pick a couple of friends or acquaintances for the witnessing. They are only witnessing our signatures, not the document, so it is not necessary to share those very private decisions with others. If you feel the need to have the document notarized, by all means do so.

It takes only a few minutes. And maybe even our own decision to involve some close friends in witnessing our signatures, if they haven't already done so, might open up their own discussion for end of life preparations.

Although not all...

Now that we have explored at least some of the terminology that is out there: living will, advance directive, durable power of attorney, health care proxy, health care directive - we get a sense of why it is important to understand what each means, and how they effect the decisions that we make, why it is imperative that we discuss our choices with our family and designate.

Of course, one reason that we need these discussions is so that we do find someone who will act as our designate (and maybe our spouse or partner isn't the one...) who will be able to act on our behalf and actuate our desires.

If our choices are to be kept breathing as long as there are medications/treatments/procedures available that might afford a cure, a chance at a normal life, a relief to our situation we need to find a designate who is willing to "go the distance" with us.

If on the other hand we have placed a limit on how much we are willing to endure, and when the time comes to "pull the plug"/stop treatments/remove feeding tubes we need to have a designate that is willing to honor our wishes, and is able to carry them through.

Either route requires our designate to be of strong will, a person of honor, someone that we can trust and is worthy of our confidence. That's a tall order.

I remember my grandmother would tell us, her family, that she wanted to be cremated. My mother, who was executor, had a very hard time with her wish. She wanted her mother to be buried next to her father. Both very realistic wishes. And very adverse.

There are times when "family discussion" of this nature can be very traumatic, with a lot of misunderstandings. It could be a very real reason why these conversations are avoided, put off for another day.

More and more often we are hearing in the political arena about having our own health directive, as seen in "paying physicians for their time in conference with you", the patient regarding End of Life discussions.

(Most) every time we enter a hospital for care or treatment we are asked if we have a directive filed with someone, our physician, with the hospital itself. It is for this moment that we need to be prepared.

Many times we know when we are going to be hospitalized.

And just as many times it comes as a total surprise.

My Living Will

And on the lighter side...

Last night, my friend and I were sitting in the living room and I said to her, "I never want to live in a vegetative state, dependent on some machine and fluids from a bottle. If that ever happens, just pull the plug."

She got up, unplugged the computer, and threw out my wine.

She's such a bitch...

(Thanks so much, Jan and Dave!)

FIve Wishes

This is a document that is definitely worth looking at, if not acquiring and calling your own!

Five Wishes, according to Wikipedia, is a national advance directive created by the non-profit organization Aging with Dignity. It has been described as the "living will with a heart and soul."

It seems to be a perfect solution. Basically it gives you everything you would want in an advance directive, and then some. It initially started in 1996 in Florida, and is now accepted in 40 states. It is a combination of a living will and a health care power of attorney.

Wish 1: The Person I Want To Make Health Care Decisions For Me When I Can't

This section is an assignment of a health care agent (also called proxy, surrogate, representative or health care power of attorney). This person makes medical decisions on your behalf if you are unable to speak for yourself.

Wish 2: The Kind of Medical Treatment I Want or Don't Want

This section is a living will--a definition of what life support treatment means to you, and when you would and would not want it.

Wish 3: How Comfortable I Want To Be

This section addresses matters of comfort care--what type of pain management you would like, personal grooming and bathing instructions, and whether you would like to know about options for hospice care, among others.

Wish 4: How I Want People To Treat Me

This section speaks to personal matters, such as whether you would like to be at home, whether you would like someone to pray at your bedside, among others.

Wish 5: What I Want My Loves Ones To Know

This section deals with matters of forgiveness, how you wish to be remembered and final wishes regarding funeral or memorial plans.

In looking at the document it does something that I am really impressed with. It is written with the assumption that you want as much done in your final days as is possible. And if there are items in the document that you don't agree with, then you cross them out. I like this because it doesn't leave you with the idea that you might have missed something, not covered all the things that you thought you might, overlooked something. It gives you the opportunity to explore ideas with yourself, and with your family.

There is a charge for Five Wishes, and it is available through the Aging With Dignity website. The price is certainly affordable at $5.00.

The document tells you which states it is legal in, and gives you the proper instructions for legally acceptable signing procedures. I highly recommend this document, if not for you to have and use, but at least to take a look at!

Power of Attorney

What is a Power of Attorney?

According to Wikipedia:

A power of attorney may be special or limited to one specified act or type of act, or it may be general, and whatever it defines as its scope is what a court will enforce as being its scope. (It may also be limited as to time.) Under the common law, a power of attorney becomes ineffective if its grantor dies or becomes "incapacitated," meaning unable to grant such a power, because of physical injury or mental illness, for example, unless the grantor (or principal) specifies that the power of attorney will continue to be effective even if the grantor becomes incapacitated (but any such power ends when the grantor dies). This type of power of attorney is called a durable power of attorney.

You can start to understand why it is that you need to know the meanings of some of these terms, and how they will effect the decisions that you and your family and physician make regarding your health care wishes.

A Living Will sets out the type of care that you would like to have as you approach your end of life, but does not allow another person to make those decisions for you. A Power of Attorney sets the parameters for another person to act in your behalf, but needs to be specific once you become ''incapacitated'' and unable to make decisions for yourself.

So a Durable Power of Attorney is one that specifically would allow your designate to make decisions for you even if you are incapacitated.

According to Wikipedia a Health Care Proxy is a document "that allows you to appoint an agent to make health care decisions in the event that the primary individual is incapable of executing such decisions. Once the document is drafted, the primary individual continues to be allowed to make health care decisions as long as they are still competent to do so... Health care proxies are by no means mandatory, rather they allow the patient's wishes to be followed even when he/she is incapable of communicating them."

Again, I am using Wikipedia as a resource, whether or not you agree with their definitions, only because it gives us the same type of page to look at from definition to definition. I encourage you to click on the related links, or use your own search engine to discover these meanings. Also, I am not an attorney, nor do I pretend to be one. I serve only to open conversation between you and your family as to your wishes.