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Who Will Make Your Medical Decisions?

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If there is anything of practical value to be gained from the attention being paid to the sad circumstances of Terri Schiavo, it might be the impetus for many of us to give some consideration to the question of who will make decisions on our behalf should we become incapacitated. These are conversations that most of us don’t really want to have. Confronting our own mortality, or that of a loved one, is not a comfortable thing. We tend not to think of these things at all when we’re young, and frankly, these conversations tend to become more uncomfortable, rather than less so, in middle age.

So where do you start? Do you have a spouse? If you don’t, do you have children, a sibling or a trusted friend who could make important medical decisions with your best interests at heart? How much do you wish to be done for you? Do you want medical science to exhaust every effort, or is there a line you don’t wish to cross? Who have you told about this? Did you impart this information during the course of a casual conversation, or have you written any of it down? If you don’t write it down, do you trust those closest to you to have the courage of your convictions when the time comes to make a decision that might end or extend your life?

If you think you’re ready to start thinking about any of this, the American Bar Association and the AARP provide a couple of starting points where you can get some of your questions answered. In most cases, it’s not as difficult as you might think, and you don’t even need a lawyer. What you do need is a willingness to give the end of your life some thought.

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About Lisa McKay

  • bhw

    Good post, Lisa. Some points to add:

    –A verbal directive is only legal/binding in some states. In others, a written directive is required. So everyone should check the law in their state and get their wishes in writing if that’s what’s required.

    –Beware the generic “living will.” When my husband and I made up our estate will, we included a living will for each of us. Our attorney spent a few hours over the course of a few weeks helping us figure out how to handle our estate, financially speaking. When it came time for the living wills, I expected him to ask us a bunch of questions about what kind of care/treatment we did and didn’t want, given the level of detail he was interested in for our $$. He didn’t. He just handed over a stardard form-letter type thing that we signed. It gave each of us the power to make medical decisions for the other and it had some vague language about extraordinary measures or some such. Not a word about specific treatments or timeframes.

    The lawyer said that if we wanted to be more specific, that we should write up a separate letter and stick it in our safe deposit box. I guess the general idea is that your wishes about specific treatments will probably change over time, and you don’t want to have to modify your will every time you want to change that.

    So, it’s very important that we all not only think about who we want making decisions for us, but that we provide them some specific guidance about how much treatment is too much, or how long is too long, or whether or not it’s okay to turn off specific life support mechanisms.

  • Excellent points, bhw, thanks. I have to admit that we have yet to fully address the issue in my own household – but we did have a tentative conversation over the weekend, so it’s a start.

  • bhw

    We haven’t written those letters for the safe deposit box either, because we’re wussies. But the Schiavo case is making it apparent that we need to do it, and sooner rather than later. I wouldn’t want my husband to doubt for a moment any decisions he made, and I would want my mother and brothers to know for certain that he was doing as I asked.

  • This is the problem. Terri never made a “living will”, so her husband may not be telling the truth. But her parents are not exactly in reality, either.

  • Jim McKay

    The other issue is that as technology and health-care change, our definitions of what constitute “living” or “extra-ordinary means” keep changing. To me it all goes to quality of life and whether “living” but brain-dead is an existence that should be preserved. A living will needs to be a dynamic document that reflects a changing view of quality of life or it should encompass timeless concepts about what you value as life or living. Keeping someone “alive” by preserving a vegetative state is selfish and self-centered and only serves one’s ability to not being able to let go. I hope that I never have to face this decision myself because rational thought in the abstract is not always possible when confronted by reality.