It's never easy to ponder death, whether you're facing the demise of a loved one or the end of your own life. But taking some time to think and plan ahead for those final hours or days can be a future blessing for your family and others close to you. Most people want a say in all life's important decisions. The same should be true regarding decisions surrounding death, such as what kind of medical treatment you receive. But what if you're unable to make your decisions or wishes known? Say, for example, you are unconscious and can't speak or hear. Unless you have spoken with your loved ones and taken certain legal actions, there may be confusion and stress over what those decisions will be and who can make them for you.
Living wills and health care proxies — documents known as advance care directives — give you a voice in decisions about your medical care. Fewer than 30% of Americans have filled out advance directives. Yet without these documents, choices may be left up to a doctor or someone appointed by a judge — a person who may not know your values, beliefs, or preferences (that is, your health care philosophy). Or, a family member who doesn't know about your wishes may make decisions for you. For example, suppose a woman is unable to communicate because of a brain tumor and her only living relative is a brother with whom she hasn't spoken in 10 years. She and her best friend have talked frankly about her desire not to be put on life support or fed intravenously. Legally, her brother may get to make such decisions, although clearly he's not the person most familiar with her desires. But if that woman had taken the simple steps to legally name her friend as her health care agent, she would have lived her last days as she wanted.
You can hope your health will be sound for the rest of your life, but there are no guarantees. So take the time to learn about and complete the necessary forms — and the sooner the better. Even if you're in perfect health, you never know when life may throw a medical crisis your way. That's why everyone over age 18 should have a living will or health care proxy. As you get older, this becomes more crucial; half of hospital stays and 80% of deaths involve people over age 65.
Advance care directives enable you to choose someone to make health care decisions for you if you are unable to do so, let you specify what kinds of treatment or goals of treatment you'd like in different circumstances, and allow a consistent plan to emerge over all by providing a base upon which to build your health care philosophy. Some people worry that by filling out these documents, they're giving up control over their medical treatment. But in reality, advance care directives help you gain control over your health care. As long as you are able to make and communicate your decisions, your word supersedes anything you've written or said to others. It's only when you're unconscious or too ill to make your wishes known that any type of advance care directive goes into effect. If your medical condition improves and you can once again make and express your decisions, your oral statements again take precedence.
Although advance care directives are important forms to complete, they're not difficult to understand, and you don't need a lawyer's help. This report will explain the process, give you tips on talking about this difficult subject, and provide you with most of the forms you need. Keep in mind, though, that forms may vary from state to state. In those cases, we provide you with information on how to obtain the right document.
601 E St., NW
Washington, DC 20049
888-OUR-AARP (888-687-2277) (toll free)
AARP is a nonprofit organization that addresses the needs and interests of people ages 50 and older. It provides information on end-of-life issues.
Administration on Aging
U.S. Administration on Aging
Washington, DC 20201
(To find Agencies on Aging nationwide, go to www.aoa.gov/eldfam/How_To_Find/Agencies/Agencies.asp)
This government agency offers information on services available to older people, including transportation, in-home help, adult day care, and support groups. It also has contact information for state and area Agencies on Aging across the country.
1700 Diagonal Road, Suite 625
Alexandria, VA 22314
800-658-8898 (toll free)
A program of the National Hospice and Palliative Care Organization, this organization provides free resources and information to help people make decisions about end-of-life care and services, including state-specific living will and health care proxy forms.
Donate Life America
700 N. Fourth St.
Richmond, VA 23219
This nonprofit alliance of national organizations and local coalitions across the United States educates the public about organ and tissue donation. The organization provides forms and information on how to become an organ donor.
Harvard Medical School Special Health Report: Living Independently in Your Later Years
Harvard Health Publications
P.O. Box 9308
Big Sandy, TX 75755
877-649-9457 (toll free)
This report can help you preserve your independence and remain in your home in your later years. It includes information on financial and legal planning, finding and working with a caregiver, and useful home modifications. Order copies of this report online, or by calling the phone number listed above.
Health Insurance Portability and Accountability Act
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Ave., SW
Room 509F, HHH Building
Washington, DC 20201
866-627-7748 (toll free)
The HIPAA Privacy Rule helps protect the privacy of personal health information.