Advance Directives: Why You Should Put Your Wishes in Writing

WebMD Live Events Transcript

The Terri Schiavo case in Florida has brought national attention to the importance of clearly documenting and communicating your wishes for medical care if you become unable to make these decisions for yourself. Everyone - regardless of age or health status - should take the time to make their wishes known. Tom Swanson, PhD, from VistaCare hospice, joined us on March 30, 2005 to answer your questions about advance care planning.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Swanson. Why is it not enough to just tell your family how you want to be treated or not treated at the end of your days?

SWANSON:
First, I would say, it is important that you communicate your wishes to your family and loved ones, but it is not enough when it comes to situations where legal determinations need to be made.

That's where documents related to advanced directives become so important. Because the documents really allows you to make a legal statement about your wishes regarding medical care if you should become unable to make these decisions for yourself. It's also extremely important that, regardless of age or health status currently, you make these written documentations now rather than wait until perhaps it's too late.

MODERATOR:
There are several different documents that we've heard about in reference to end-of-life decisions. Can you please explain the various documents and their purpose?

SWANSON:
When speaking of advanced directives, there are three types of legal documents that generally apply:

• A living will
• A health care power of attorney or medical power of attorney
• A do not resuscitate order or DNR

All three documents let you give very clear instructions about the medical care you want to receive in the event that you become unable to speak for yourself because of a serious illness or being incapacitated.

These are important because they're not only a legal document for the courts and the state you live in, but they also communicate clearly your wishes to your family, physician and other medical personnel that you may encounter during health care crisis.

Advanced directives are important because they help insure that the patient's wishes are honored, they prevent or minimize conflict between family members during a difficult and emotional time, and they can ease the burden for family members who have to make decisions on behalf of the patient. When making those decisions, they will know rather than having to guess or end up feeling guilty, because they know that this is what the patient and their loved one really wanted.

MODERATOR:
What does a living will entail?

SWANSON:
A living will is a document that states the patient's wishes about withdrawing or withholding life sustaining procedures. A living will usually documents the patient's wishes in regards to several medical treatments:

• Cardiopulmonary resuscitation or CPR
• Artificial hydration and nutrition
• Mechanical ventilation
• Blood dialysis and transfusions
• Surgeries
• Medications

A living will asks an individual what their preferences would be should they find themselves in a life-limiting illness or perhaps find themselves in a persistent vegetative state.

It's important that a living will be completed by a patient while they have the capacity to do so, which is another reason why it's important to complete a living will before a crisis occurs. Capacity can be defined by the ability to comprehend information, contemplate options, evaluate risks and consequences, and communicate decisions.

MEMBER QUESTION:
I'm worried because I've heard that even if you have a living will, the doctors can still insert a feeding tube and then refuse to unhook it.

SWANSON:
It's important with a living will that you not only complete it, but that you communicate clearly your wishes that are on the living will with your family members, physician, and in choosing a medical power of attorney, to make sure they have a copy also.

Sometimes a doctor may not have the actual living will in the medical chart, so in the absence of a hard copy, they won't necessarily accept somebody's verbal acknowledgement of that. If you have a hard copy, it's unlikely a physician would override that, but certainly that can happen.

MODERATOR:
And if that would happen and the family then presents the hard copy, would a physician then be required to remove the feeding tube?

SWANSON:
I'm not sure if a physician would feel required to do so, but if the family produced the document and the family members and medical power of attorney were all in agreement, I think the physician would honor those wishes. If for some reason he felt an ethical conflict, the physician might bring this case to the hospital ethics committee. But most often, in my experience, physicians will honor a living will document, particularly after they've consulted with the medical power of attorney.