Gabriel Katzner - November 30, 2020 - Estate Planning
healthcare power of attorney and living will

Mary and her mother, Louise, have just met with Louise’s estate attorney. Louise wanted to update her living will (advanced directives) and healthcare power of attorney. Louise has not updated these documents in thirty years, and her wishes have changed. She plans to move into an assisted living facility within the next six months and would like Mary to have the power to make any medical decisions she is incapable of making. This meeting with her attorney ensures all paperwork is up-to-date and allows Louise and Mary to understand their roles and responsibilities.

What to include in a living will

Suppose Louise should become ill enough that she cannot make sound medical decisions for her care or cannot communicate her wishes to the medical staff. In that case, she can rely on Mary to do so for her. First, Louise needs to express how she envisions her end-of-life. A living will or advanced health directive is a document that allows Louise to spell out her preferences regarding medical interventions for end-of-life care ahead of time. With an advance directive, Louise retains full autonomy over her healthcare decision-making even when she can no longer express her preferences. Louis plans to include instructions for:

  • Cardiopulmonary resuscitation (CPR): If her heart stops beating, would she want it to be electrically stimulated or receive CPR? 
  • Breathing machine: If she cannot breathe on her own, would she want to be put on a breathing machine? 
  • Dialysis: If her kidneys stopped working, would she want dialysis to remove excess waste and fluid from the blood? If so, for how long? 
  • Tube feeding: If she cannot eat or drink, would she want a tube into her stomach to provide calories and fluids? 
  • Antibiotics/antivirals/antifungals: If she would get an infection, does she want to receive medication to help her fight the infection? 
  • Comfort Care: What comfort measures does Louise value? Examples may include dying at home, receiving pain medications, having access to ice chips for a sore throat.  
  • Organ Donations: How does she feel about organ donation? Louise needs to understand the organ donation process and express her understanding and wishes regarding what organs she might be comfortable donating. 
  • Blood transfusion: Does she want to receive blood transfusions? Blood transfusions may be required to increase blood volume or correct anemia after surgery, an accident, or an illness. 

If Louise should have a serious illness or medical condition, she can stipulate any changes she would make in her healthcare wishes based on this condition.  Even if she did not have an advance directive, Louise could still express her preferences on whether she would like to be intubated or resuscitated. Once Louise completes her advanced directive, she must ensure that her document is shared, so all relevant parties understand her wishes. 

Points to consider

As Louise’s healthcare power of attorney, Mary can ensure that Louise’s wishes are made known to every healthcare provider. Louise chose her healthcare power-of-attorney carefully. She needed to believe that Mary would honor her wishes. If Louise were in a medical situation not spelled out in her advanced directives, Mary would need to decide for her based on what she thought was in Louise’s best interests. If Louise ever felt like Mary would not honor her wishes or make decisions aligned with her beliefs, Louise would need to update her healthcare power of attorney immediately, because unfortunately, you never know when you will need it. 

The pandemic has made many people pause to consider what healthcare they would want to receive if they became seriously ill and who would make these wishes known. Mary plans to meet with the estate attorney next to develop her own living will and name her healthcare power of attorney and start her estate planning


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