Find Peace of Mind in Planning Ahead
Peace of mind comes with making a plan, especially when it comes to expressing your wishes for your medical care, your finances and your desires about the end of your life and after you die. Legal advance directives are documents that give others the authority and directions to carry out your wishes when you are unable to or when it’s more convenient for someone you trust to do so for you.
Four Essential Legal Documents
Advance directives are legal tools that ensure a person’s wishes concerning their healthcare and finances are carried out should they become unable to express them. Everyone should have these documents on file no matter what their age. If you are helping your loved one create their advance directives, consider using this as an opportunity to write down your own desires and file your own advance directives. Documents you and your loved one should have include:
A living will
A healthcare power of attorney
A durable power of attorney
A living will address end-of-life issues, such as requesting or withholding medical treatments.
A healthcare power of attorney is broader and allows the person you appoint, who is also known as a proxy, to make medical decisions on your behalf if you are unable. For instance, if you are in a stable coma, your healthcare proxy could make decisions about your everyday care. Both the living will and the healthcare power of attorney are activated only when a physician declares the patient unable to give consent.
A will deals with the division of property and assets after death.
The durable power of attorney allows for the appointment of someone you choose to manage financial affairs should you become incapacitated. You decide on the scope of the durable power of attorney and under what conditions it is activated. Durable power of attorney ends at death. The executor of a will, who can be the same person who has durable power of attorney, then takes charge of the estate and financial affairs.
Consider Professional Help
You don’t have to use an attorney to create advance directives but you may feel more confident doing so.
State bar associations and government agencies can often be resources for instructions and forms for living wills and healthcare powers of attorney. In addition, most area hospitals and hospice organizations have forms and are glad to assist you with completing them. Be aware, though, that these directives must be properly executed and witnessed to be valid.
Will and durable power of attorney forms can be downloaded from various sources online as well. However, unless your life is very simple, think twice about executing these documents without the assistance of a lawyer. An attorney can be especially helpful if you have had multiple marriages or have stepchildren, grandchildren, a large estate, a business or other complex life situations. With all advance directives, there is a lot to consider that is unique to you or your loved one and much is riding on the paperwork being properly done. While you can “do it yourself,” talking with a professional is prudent.
What Your Directives Should Say
The wishes expressed in advance directives are up to the person drafting the document. The downloadable forms contain good prompts to ensure you ask and answer important questions and cover many bases.
However, these documents cannot address every situation so in addition to getting your wishes down on paper, make sure that all involved understand the underlying spirit of those wishes as well.
A family meeting is a great way to accomplish this. Frank discussions face-to-face with all concerned parties allow people to ask questions, sort out possible misunderstandings and come to terms with what their loved one wants. Such a meeting – strengthened by legal documents that reflect the content of the meeting – provides the proxy and other family members with direction and peace of mind when tough decisions may need to be made.
Who Should Have the Power?
The toughest decision for many when putting these documents together is deciding who should receive their healthcare and durable powers of attorney. The proxy needs to be someone who knows the person and sees his or her life in context. The proxy also should understand the responsibilities and agree to the job.
Although a spouse or partner may seem like a natural choice, he or she might not be the best proxy. Typically, spouses and partners are about the same age so issues of aging can present problems.
Appointing all children equally is another popular option. However, before making such a decree, consider, based on past experience, if this sibling group can reach a consensus on sometimes complicated and tension-filled decisions. On the other hand, realize that appointing one child as the sole proxy can lead to its own set of problems.
If the family dynamic won’t fare well with a group or individual being appointed, consider asking a close family friend or choosing a professional to do the job.
Whomever you select, think about that person’s natural strengths and weaknesses. One child or close friend might be great for financial matters while another might be better with healthcare issues.
Keep Directives Up-to-Date
Situations change over time so you should update all of your directives every five years or more frequently as needed to be sure they still reflect your circumstances and desires.
Once completed, keep a file at home with several copies of all of your advance directives. Share copies with your agent, alternate agent and health care providers. Do not store them in a safe deposit box because people who need them may not be able to access them. Scan these documents onto your computer for quick reference and so you can send them electronically to any appropriate entity that needs them. Keep an electronic set on your phone and in the cloud, too, and register your advance directives online.
Instructions and forms for North Carolina living wills and healthcare powers of attorney are available at SOSNC.gov/AHCDR.
This site also is home to the N.C. Advance Health Care Directive Registry where you can file up to four different advance directive documents for easy access.
South Carolina advance directive instructions and forms can be found at Aging.SC.gov/Programs-Initiatives/Legal-Assistance-Seniors.
Medical or Physician Orders for Scope of Treatment
Medical orders for scope of treatment (MOST), physician orders for scope of treatment (POST) or portable orders for life-sustaining treatment (POLST) are other types of medical directives.
Issued through your healthcare provider as you approach the end of your life, a MOST, POST or a POLST is more detailed than a do not resuscitate or DNR order or a living will. The terminology for these kinds of orders varies from state to state.
These types of advance medical orders allow you or your proxy to decide what specific treatments or interventions you wish to have and which you don’t depending on your particular condition.
Typically, they work with your DNR and living will and also can temporarily suspend any conflicting orders. For example, you may have such a directive that instructs your provider to perform surgery or offer a treatment that your living will might prohibit.
You and your physician, physician’s assistant or nurse practitioner fill out these medical orders together and they must be signed by both of you
For more information, ask your physician and visit the North Carolina Medical Society at NCMEDSOC.org/AdvocacyPublic-Health/End-of-Life-Resources, the S.C. Dept. of Health and Environmental Control at SCDEHC.gov/Physician-Orders-Scope-Treatment-Post and the National POLST at POLST.org.