Brandywine Family Medicine

End of Life Care and Living Wills

Published 06.11.2021

Everyone dies at some point, but you have more control than you think if you plan ahead. Everyone should have a durable power of attorney for financial and legal affairs and a durable power of attorney for medical affairs. They can be the same or two different people. Everyone should also have a will that you update regularly. You and whoever you appoint as your power of attorneys should always have up to date signed and notarized and witnessed copies of these documents. I recommend keeping copies of these in a ziplock bag on the fridge where they are easy to grab if you are older with updated contact information for family members and your power of attorneys. The ambulance crews usually look there for information. The hospital and physician caring for you will usually only speak with one person ie the durable power of attorney for medical affairs or closest relative. Even if you have lived with someone for 20 years unless they are your PoA the hospital is going to speak to your closest relative- a spouse, parent, or child etc even if you have had no contact with them in years. The situation can get complicated very quickly.

Pick someone for your PoA who thinks like you and understands your priorities for health care. Write down your feelings in a letter to them with some scenarios for them to follow. For example if I had a major stroke and am not expected to be able to walk or talk again I would not want further medical care and wish to be made comfortable only. If I had cancer that has spread in my body and chemotherapy isn’t working anymore or is too taxing for me I wish to enter hospice care. I don’t want any care that doesn’t have at least a 50% chance of getting me back to a functional independent person with rehab. If I have been put a ventilator because of pneumonia or cardiac arrest and things aren’t improving in four or five days so that there is a good chance of me recovering and living alone again then take me off supportive care and just make me comfortable. I value quality of life way more than quantity of life.

Or you may be someone who wants every single last possible day they can get on earth no matter what condition you are in. Everyone is different and has different values. There is no right answer. You want your PoA to make the choice that you would make if you were able to. The more information you give them about your feelings and beliefs makes the job easier for them. Would you want to live for an extended period of time in a nursing home or would you rather do everything you can to live at home even if that meant you aren’t necessarily safe at home alone. You want your PoA to feel like they are just expressing your wishes rather than making decisions for you. Sometimes loved ones just can’t say no to care even if that is what you would have chosen. Pick someone who can say no, this isn’t what they wanted. Is your family member, child or spouse going to be able to say this. If there is a family member you trust, often someone in healthcare works well, use them. But if a friend understands your wishes use them. Just keep all the documents up to date. Update yearly on your birthday or with any major life change.

If you get sick and go to the ER by ambulance they are going to do everything they can to save your life first. They don’t ask about living wills or PoA they just do what they can. The legal stuff gets sorted out later. Don’t think if you get sick you will be able to keep making decisions for yourself. Severe abdominal pain, problems breathing, chest pain and infection can really mess with your head and keep you from thinking clearly very quickly. Have a plan. In the hospital if there is any question about what should be done medically for you they are going to err on the side of caution and provide a treatment even if it has a low chance of success, unless you have a PoA to make decisions for you if you are incapacitated. Things happen very fast in the medical world and there isn’t always time to have a debate with the patient and family about the pro and cons of treatment. Doctors and hospitals are always going to tend to do something if there is an option. If you believe though that just because something can be done doesn’t always mean it should be done then have a PoA.

PoA is a much stronger document than a living will. A living will only really applies to end of life, terminal situations. For a couple of doctors to agree that there are no more options to try means you are already pretty far gone. Rarely does someone get diagnosed as terminal at one time. Usually, there are many smaller decisions to be made along the way like ventilator, feeding tubes, surgery that may help but probably won’t. Living wills don’t really help with the majority of emergency or hospital decisions. Get the PoA.

You also need a PoA for financial and legal affairs. If you were in an accident and couldn’t write a check for a month who would take care of the car issues, the house, and bills. Give someone a PoA if you have kids to make decisions for them in case you can’t or are away. Family situations can get very ugly very quickly. Address the possibilities ahead of time and update the paperwork regularly.

If you anticipate family discord or you have a complex situation you should definitely consult an attorney. If you just need straightforward PoA and will forms you can use an online service like LawDepot or Rocket Lawyer. Have something down on paper. I think dealing with a death in the family for someone who has no will or directives is one of the hardest thing for people and families to deal with in their life. People get funny ideas about what they should get or have rights to and the stress can be unbelievable. Get the signed witnessed documents to make sure your wishes are followed. Have a will with a detailed letter about what you want for your funeral arrangements. Who gets what with your personal belongings and finances. Be realistic, everyone dies.

Hospice care doesn’t mean that everyone is giving up on you. It is just medical care based in reality. If transfusions are going to make you feel better they will still do them. If you want an antibiotic for an infection it will be given to you. Hospice just values quality of life over quantity of life. They want you to be comfortable and taken care of for the end. Most families wait too long to start hospice care and wished they had reached out sooner. They do what they can to support the patient and the family. They have counseling and nondenominational religious support if that is what you want. Most people find it a positive experience.

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