Healthcare Directives

Everyone should have a healthcare directive, also called a living will. It is a legal document that states your wishes if you should be in a life ending situation, with no hope of recovery, and don’t want extraordinary measures taken that can never return you to any meaningful form of life. Whether you are age 20, or 80, and have a normal quality of life, and are in a car accident and are bleeding to death, its common sense that you want the EMT’s to do all in their power to keep you alive. The saying “I don’t want anything” really means you don’t want extraordinary means taken to prolong life when there is no likelihood of returning to a decent quality of life. Here is a more complete explanation.

If someone of great age (or even a younger person) due to physical or mental conditions has no meaningful life, such as a severe stroke victim, who cannot communicate, or move or eat, or is permanently unconscious, may very well not want to live in that condition. That person may want a DNR, which means a Do Not Resuscitate order. In Connecticut, only a doctor can issue a DNR, either under direction of the patient, or if the patient cannot communicate, by the family, assuming there are no family disputes. With a DNR, no extraordinary means or even normal means would be given to preserve life. A DNR is not the same as a living will.

A living will usually states the patient’s desire not to be kept alive by extraordinary means, if the attending physician is also of the opinion that there is no reasonable prospect of returning to any kind of functional or meaningful life. The words I use are not technical ones, but convey the intent of the living will law in Connecticut. The intent is to allow anyone to go in peace without enduring extraordinary measures which would only prolong the suffering of someone who would never regain any semblance of a meaningful life. With a living will, the medical people will give all the care necessary to keep you alive as long as there is a decent chance that you will recover.

In practical terms, this means that your health care directives (living will and appointment of a health care representative) will guide the doctors and your chosen decision maker in deciding which procedures should be performed, and which should not. For example, most living wills direct no artificial means of nutrition and hydration, no CPR, no dialysis and no antibiotics other than for comfort. Keep in mind that these procedures will only be withheld if you are in that terminal situation where there is no realistic likelihood of a functional recovery, or are in a permanently unconscious or minimally conscious state. This is a far cry from someone near death due to accident or a medical problem that could be cured by the medical procedures today.

The key to a living will is choosing a health care representative who feels the same way you do and who can bring themselves to make that difficult decision. People usually name their spouses and then one or another of their children as backups, but if that child could never bring himself or herself to say stop the machines, the decision might not be made. A simple rule of thumb is to choose those family members who have the judgement and emotional ability to make such a decision, and tell them personally that those are your wishes and you want them to make that decision, if it is ever necessary. Telling them personally will make it easier to make that decision without a feeling of guilt.

Where should that advance directive should be kept? Certainly in a safe place that your health care representative knows about and has access to. Ideally that person should have possession of it. After all, if you are in that situation you won’t be able to tell them where it is, and often that person may not live near you. It’s ok to give your primary doctor a copy, but that doctor may not be the attending physician years later, or if you are in a hospital in another town, so it is important for your chosen decision maker to have access to the living will. This is one of those legal tools that we all need, and should give some thought to, and then do it. It may serve you well, and save your child or other decision maker from holding back in case that situation ever arises.

Attorney Stephen O. Allaire is Of Counsel and Attorney Halley C. Allaire is principal in the law firm of Allaire Elder Law, members of the National Academy of Elder Law Attorneys, Inc., with offices at 271 Farmington Avenue, Bristol, (860) 259-1500, or on the web at www.allaireelderlaw.com. If you have a question, send a written note to either attorney at Allaire Elder Law, LLC, 271 Farmington Avenue, Bristol, CT 06010, and they may use your question in a future column.