Information Essential for Crafting a Living Will
A Straight-Up Guide to Crafting Your Living Will in Washington State
Dealing with end-of-life care discussions can be uncomfortable, especially when you're feeling peachy keen. But facing the music now can deliver you and your beloved ones some well- deserved peace of mind.
"Planning ahead for the potential unknowns of serious illness or the end of life calls for discussions with your trusted healthcare advocate and provider," stresses Dr. Lucille Marchand, an palliative and integrative medicine whiz who works at UW Medical Center - Montlake.
So here's a crash course on advanced care options and essential wisdom before you write your living will.
What, Exactly, is a Living Will?
You might come across phrases like "living will," "advanced healthcare directives," or "directive to physicians," tossed around in discussions about end-of-life care. These terms are like different names for the same thing: legal documents that essentially tell your doctor about any medical treatments and life-saving measures you'd prefer to receive near your final breath, specifically in situations where you're unable to express your wishes.
In Washington state, this document goes by the colloquial name "living will" and is officially termed a Health Care Directive. A lawyer can whip up this doc for you, but you can also go the frugal, do-it-yourself route by using free, online tools.
A living will differs from another popular healthcare directive in Washington: physician orders for life sustaining treatment (POLST).
Anyone can create a living will, regardless of health status, but it requires notarization or witnessing by two non-related individuals. On the flip side, a POLST is typically intended for those with severe health conditions and is made with a healthcare provider.
What's in a Living Will?
In Washington, a living will details the treatments you'd want if you're terminally ill or permanently unconscious, which Marchand defines as a state where recovery of consciousness is not feasible or would take an uncommonly long time. The treatments covered include:
- Artificial nutrition
- Artificial hydration
- Artificial respiration
- CPR (including ventilation, medication, stimulants, and other heart failure treatment)
- Surgery
- Blood dialysis
- Blood transfusion
- Medication
- Pain management
Overflowing with medical lingo, the document might leave you scratching your head as you pore over it. And remember, the best medical practices often vary from person to person.
"Sometimes the document can seem a bit more technical than realistic," says Dr. James Fausto, medical director for palliative care at UW Medicine.
For instance, deciding in advance on artificial nutrition and hydration can be tough without knowing your diagnosis, prognosis, or clinical situation. Doctors will never deprive you of food or water, so you'll still receive sustenance, even if you opt out of artificial nutrition and hydration. These terms specifically refer to tube feeding or intravenous feeding, which can be lifesaving in some cases but potentially ineffective or painful in others.
The takeaway? Creating a living will isn't a walk in the park, and it's essential to know precisely what you desire – a fact that may change as circumstances evolve.
Essential Knowledge Before Crafting a Living Will
With all this in mind, how do you embark on making advanced healthcare decisions? Here are three vital tips to streamline end-of-life decisions.
Assign a Durable Power of Attorney for Healthcare
According to both Marchand and Fausto, the crux of end-of-life care is the selection of a durable power of attorney for healthcare, or a healthcare agent.
"Basically, you appoint a person who can voice the spirit of what you'd want, should you be incapacitated by a condition," Fausto explains.
Think of this individual as a trusted person who comprehends your preferences and can advocate for you in a critical medical situation. They must be 18 or older and cannot be an employee of your healthcare provider, unless that person is a relative.
Selecting a healthcare agent is crucial, as medicine constantly evolves. In the case of a living will, you could accidentally deny yourself access to a cutting-edge treatment due to what you wrote years earlier. Your healthcare advocate can evaluate whether new treatments are appropriate based on their comprehension of your healthcare wishes.
One thing to note: If you reside in Washington state, are single and haven't chosen a healthcare agent, your parents will be your defaults. If you're single, married, or without living parents, the defaults are your spouse, then your siblings, and so on. If you prefer someone other than family to serve as your healthcare agent, it's crucial to make that choice.
Ponder Your Healthcare Values
Before you knee-deep in the business of filling out a living will, it's wise to contemplate your healthcare values. A healthcare value form can help you do just that. Many living wills include a healthcare values form, but you can also complete the form separately and share it with your healthcare agent and doctors.
In essence, this form is where you express your concerns, such as stress over choking, desires to spend your final days at home, or religious, cultural, or traditional healthcare practices you find important. Some forms also have sliding scales that clarify your priorities, such as preserving your quality of life, living for as long as possible, being self-reliant, or passing away swiftly without lingering.
If this appears overwhelming, don't sweat it. The purpose of this form is to lay the groundwork for what your healthcare wishes are so that you can convey these to your healthcare agent and doctor.
Begin the Conversation
Once you've pinpointed your values, share them with your healthcare agent. Discussing serious illness and death may feel awkward and emotional, but resources like the "death over dinner" movement and "end-of-life care card decks" can ease the dialogue.
For Fausto, the best approach is to bring up the topic when asking someone to be your healthcare agent. "Start by sharing any end-of-life experiences you've had with loved ones and what aspects terrified you or would've comforted you in that situation," Fausto advises.
You can also seize the opportunity to discuss your preferences when healthcare-related incidents occur in the news. The conversation can be as formal or casual as you wish, as long as your intentions are understood.
Once the dialogue has started, you can then decide whether you'd like to complete a living will or simply have a healthcare agent designated.
"For some individuals, creating a living will hits the mark. For others, it doesn't resonate at all," Fausto concludes. Whether you finish a living will, select a healthcare agent, or do both depends on what you're comfortable with. But ultimately, taking action to be prepared is key.
"In addition to estate planning, it's also important to consider other aspects of health-and-wellness when crafting your living will. For instance, keeping abreast of current news in the realm of relationships and mental health can help you express your wishes clearly during challenging times.
Moreover, being aware of the latest research in nutrition and science can help you make informed decisions about your preferred treatment options, particularly regarding artificial nutrition and hydration. Understanding the benefits and drawbacks of various methods will empower you to achieve the quality of life you desire, as articulated in your living will."
