Dear Vail Valley Doc: Make end-of-life decisions now
Vail, CO Colorado
VAIL, Colorado “-You may have heard the saying that the only two things we can be sure of in life are death and taxes. Isn’t it odd then that we spend so much time preparing for one, and so little for the other. In truth, preparing for death can be a blessing at the end of our lives for ourselves and those we love. With some help and forethought, it can even be easier than doing our taxes.
A lot of my friends and neighbors haven’t thought about a living will. No matter how old you are, I know how important it is. Could you tell people about living wills?
Thinking about the future in Eagle
Thank you for a great and very important question. If you have assets, and especially if you have children, having a will has likely been suggested to you. It protects all you have worked so hard for and assures that those important to you will benefit from that after you are gone.
While a “Last Will and Testament” is important, it is equally important to plan for your last days, weeks and months before that last will is called into effect. Medical decisions near the end of life are difficult, emotional and frequently come with an urgency that stresses an already tense situation. Not infrequently, these decisions are left to family members if your health has left you unable to make them personally.
There are actually several documents to consider. Each fulfills an important and distinct role. They include the living will, the health care proxy, the DNR or do not resuscitate order and the durable medical power of attorney.
A living will is a document that supports medical decisions you make in advance of a serious health condition. It may cover such important decisions as receiving CPR (Cardio Pulmonary Resuscitation), mechanical ventilation to breathe for you if you are unable and even artificial hydration (fluids) and feedings. It is important to know that a living will only comes into effect under two conditions. The first is of course that you are unable to make or express such decisions yourself. The second condition is that two physicians independently confirm that you have a terminal medical disease or illness.
Like a living will, a health care proxy comes into effect only under those same two conditions. It identifies an individual (and usually an alternate) who, if needed, have authority to make medical decisions for you. That person has enormous responsibility. It is important then to have regular open and honest conversations about your final wishes with them. He or she should have a copy of your living will and be ready to make decisions for you in support of that document and the conversations you have had.
A DNR order or do not resuscitate order can only be written by your physician while you are in a hospital, nursing home, or other medical facility. It specifically limits, by your choice, what are called heroic measures in the event your heart stops or your lungs fail. Not specifically part of the DNR order, but equally important, are those life sustaining measures that you may or may not wish to receive. This may include intravenous fluids and artificial feedings, antibiotics and other life prolonging medications. A DNR order, signed by your physician, may also be an important document to have at home or in a nursing home as it helps guide emergency personal who are responding to a life threatening emergency.
A durable medical power of attorney is a legal document giving very specific powers to someone you name regarding medical decisions, sharing of health care information and signing legal documents on your behalf. It too is in effect only upon the presence of the two conditions I described in living wills.
Finally, it is important to know that each of these end-of-life documents can be changed, modified or rescinded at any time. Think about your wishes in the event you suffer a terminal medical condition from which you are not expected to recover, and experience a decreased quality of life. Talk about it with those important to you, as well as your physician. While living will and health care proxy forms are readily available, it is always a good idea to also discuss these decisions and documents with your attorney. In Colorado, and 40 other states there is a document titled “5 Wishes.” It can be viewed online at http://www.agingwithdignity.org/5wishes.html. For most people it is all you need and at the least, serves as the foundation for your personal end of life decisions. Ask your doctor if he or she has a copy they can share with you. If you live outside of Colorado, check with your physician or attorney to see which end-of-life documents are recognized in your state.
Remember your health is your responsibility! Health is our greatest asset and it doesn’t happen by accident. If something doesn’t seem right, or questions are left unanswered don’t wait, call your doctor.
Dr. Drew Werner is the vice chief of staff at Valley View Hospital in Glenwood Springs and the Eagle County Health Officer. He lives in Eagle with his family. E-mail comments about this column to firstname.lastname@example.org.