Directing your own end-of-life care

September 16, 2005

Your patients aren't the only ones who need advance directives. Here's how to prepare your own.

No matter what side of the Terri Schiavo debate you were on, you certainly don't want to subject your family to the sort of long, drawn-out nightmare we all witnessed this past year. Of course, you know that putting your intentions for your end-of-life care down on paper can give you some peace of mind. You may even discuss the subject with your patients. But doctors are notorious for failing to take their own good advice.

If you haven't planned for your own end-of-life care, you need to draw up two documents: a living will and a healthcare power of attorney.

What advance directives should say

Some living wills are fairly simple, just stating that no "heroic measures" be taken. Others can be extensive, such as the one drafted by gastroenterologist Patricia Raymond, in Chesapeake, VA. Her family is instructed to "do everything possible for six months. If after that time, I'm not interacting with my family, or seeming to enjoy my environment, they're to stop food, water, and any antibiotics. I don't have to be persistently vegetative or brain dead, just noninteractive and nonjoyful."

Note that Raymond instructs her family to take all necessary measures for a specific period of time. So much attention has been brought to the Schiavo case and others involved with "pulling the plug," that it's often overlooked that a living will can also specify your wishes if you prefer to have all possible steps taken to prolong your life, no matter what your condition.

But a living will can't possibly cover all the different end-of-life scenarios. That's why many experts agree that a healthcare power of attorney is the more important of the two documents. It enables your stated agent or proxy to make decisions about your care in the way you would have wanted, no matter what the situation. This person can make healthcare decisions for you at any time you're unable to make them for yourself, whether you're in the throes of a serious illness from which you're likely to recover, or you're on your deathbed.

Your directions in the power of attorney document can be simple or very specific, but what's most important is that you communicate them clearly to your agent. Be sure to share your wishes with your agent not only in writing, but also in an in-depth conversation. "The form is only as good as the discussion it's based on," says Charles Sabatino, director of the American Bar Association's Commission on Law and Aging. The key to preparing effective advance directives is open communication with your loved ones now, while you're able.

Deciding who should be your proxy can be difficult. The person who first comes to mind (probably your spouse) may not be the person best suited for the job, says Kathryn Tucker, director of Legal Affairs with Compassion & Choices, a consumer advocacy organization. You need to choose someone who, besides being close to you, is "willing and able to be a vocal and tenacious advocate for your wishes, not someone who is easily intimidated or unable to stand up to authority," advises Tucker.

Retired hospital executive Peter Rogatz, in Roslyn Heights, NY, named his wife as his proxy, with his son as alternate. He used the standard New York state proxy form, and wrote his own detailed advance directives. To instruct his wife and son in fulfilling his wishes, Rogatz also wrote a cover letter. It tells them to rely first on their status as proxy in withdrawing or prolonging life support, and to "keep the living will in their back pocket," to use only if they can't get doctors or nurses to accept their decisions on the basis of their proxy power alone.