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Make end-of--life decisions in advance to help you and your family avoid stress later.

According to a recent study (Journal of the American Geriatrics Society, April 2), a record number of older adults are completing advance healthcare directives (also known as living wills) to guide end-of-life medical treatments--up from 47 percent in 2000 to 72 percent in 2010. Clinical social worker Sheila Barton, LCSW, with the Martha Stewart Center for Living at Mount Sinai, sees this as a positive development. "By considering and recording your options early, you can ensure the quality of life that is important to you while avoiding futile treatments," she says. "You need to be able to evaluate these measures during normal times, and while you are able to effectively communicate your wishes--not during a medical crisis."

Barton notes that a living will also frees your loved ones from the pressure of having to make critical medical care decisions for you while they are under stress or in emotional turmoil. "If your health takes a turn for the worst, it provides peace of mind to know that your doctors have a blueprint in place to guide them in how they treat you, and a legal statement in respect of any treatment refusal decisions you have made," she says. "Research shows that patients and their families report significantly less stress, anxiety, and depression when a living will is in place."

How to set up a living will It isn't necessary to appoint a lawyer to complete a living will, although lawyers do routinely draw them up as part of estate planning. If you decide to complete your own living will, state-specific forms can be obtained from your doctor or your local health department, or downloaded via Caring Connections (see What You Can Do).

"A living will is only utilized if you are too ill to make medical care decisions yourself, and you can revoke yours at any time, both orally and in writing," Barton says. "Keep in mind too that a living will remains in effect until you change it, so you should review yours from time to time, to ensure that it still reflects your wishes, and takes into account any medical advances that may affect possible treatments." The American Bar Association recommends you also re-examine your health care wishes if you divorce, particularly if your previous spouse was named as your health care proxy (see below), if you are diagnosed with a serious medical problem, and/or you experience a significant decline in your health due to an existing medical problem.

Naming a proxy Living wills include a health care power of attorney (POA), which is a legal document that names a health care proxy who can take steps to ensure that your wishes are carried out. "Your proxy would be the one to ask difficult questions of your doctors, and make decisions about tube feeding, breathing machines, resuscitation, and other end-of-life options," Barton explains.

A proxy can be a spouse, child or other relative, or a close friend, and you should discuss with him or her the quality of life that is important to you, and medical treatments you would rather not have. "Keep in mind that they may have to be assertive about asking questions of your doctors, and make decisions under difficult circumstances even if other members of your family disagree with your requests," Barton says. "Make it clear to your family and your doctor that your proxy is the person you want to make potentially difficult decisions about how to interpret your living will." For practicality, your proxy needs to live near you, so he or she can meet with your doctors, and it makes sense to choose someone who shares your end-of-life morals and ethics.

Should you include a "DNR"? You may want to consider including a do not resuscitate order (DNR) as part of your living will, since a living will alone does little to protect you from unwanted emergency care, such as cardiopulmonary resuscitation (CPR). "Paramedics are required by law to attempt resuscitation on unresponsive patients in emergency situations outside of a health care institution, and transport you to hospital for stabilization, unless they are shown a valid DNR form," Barton confirms. "You'd need to have a separate DNR in place to prevent resuscitation attempts during an emergency situation."

Alternately, you may want to consider setting up a Physician's Orders for Life Sustaining Treatment (POLST). "These were developed in response to concerns that traditional living wills and DNRs don't adequately communicate patients' wishes for the care they would like to get at the end of their lives, particularly with regard to resuscitation measures," Barton explains. "A POLST allows you to specify whether or not you wish to receive CPR or be transferred to hospital, so that emergency medical personnel have clear orders on which actions to take."


For more advice on living wills, including tips on how to talk to your doctors, visit Prepare for Your Care (

Living will forms can be downloaded from Caring Connections (

POLST forms can be downloaded at via the site's Resources link.

Communicate and explain your wishes to your family members at the time you prepare your living will, especially if you think they may object to your decisions.

Provide copies of your living will to your family, health care proxy, and doctors, to help prevent stress and arguing later.
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Title Annotation:INDEPENDENCE
Publication:Focus on Healthy Aging
Date:Aug 1, 2014
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