It Takes More Than a Living Will
http://www.washingtonpost.com/wp-dyn/articles/A2623-2005Mar26_3.html
By Albert B. Crenshaw
Sunday, March 27, 2005; Page F01
A theme running through coverage of the tragic case of Terri Schiavo is that if she had only had a living will, the long-running controversy over whether to preserve her life in what court-appointed doctors have called a "persistent vegetative state" could have been avoided.
But living wills, while desirable, are only part of the package of documents that Americans today should have in order to resolve not only end-of-life issues but also broader questions that arise from serious medical conditions
Experts recommend that the medical and end-of-life documents be part of a broad estate plan, one that includes a regular will and perhaps trusts and other legal instructions that will result in an orderly disposition of a person's property and affairs in ways that minimize family strife, taxes and other costs.
"That's ideal," said attorney Deborah A. Cohn of Paley, Rothman, Goldstein, Rosenberg, Eig & Cooper in Bethesda, "but frankly, if the only issues a person is willing to address are these medical ones, [doing that] at least . . . solves that problem."
The medical issue is most significant for many people. For example, if a young person with few assets dies
intestate (without a will), survivors may face some inconvenience, but nothing that is likely to cause a family disaster. However, if such a person ends up in a coma and the family has no instructions and members disagree over what to do, a Schiavo-like situation could emerge, potentially splitting the family and draining its assets in legal wrangling.
So having the right documents is not just an "old people's issue."
The key items to have for medical issues are:
• First, a paper that appoints someone as your agent and authorizes him to make medical decisions for you if and when you cannot. Terminology differs, but this paper is typically referred to as a medical power of attorney, power of attorney for health care, health care proxy or something similar.
• Second, a paper that provides a set of instructions, governing what treatment you do and/or don't want in the case of apparently terminal illness. This document is generally called a living will
Taken together, these two documents constitute an "advance medical directive," and this is the package that everyone should have. Indeed, many states now offer forms combining them.
Other items can be added.
For example, some attorneys recommend a separate HIPPA authorization to enable your agent to receive medical information about you. Your medical power of attorney becomes effective when you are incapacitated, but HIPPA, the Health Insurance Portability and Accountability Act of 1996, imposes tough privacy rules on doctors, raising the possibility that without special authorization your agent may not be able to obtain the information necessary to invoke the power of attorney.
Also, there are special instructions, such as a "do not resuscitate" (DNR) directive, that some people, such as those in the last stages of a terminal illness, may wish to include. "People should understand that a living will is not a DNR. If they want the DNR, they should get that," Cohn said.
Conceptually and mechanically, advance medical directives are fairly simple. Blank forms are readily available online, at hospitals and from state agencies. Many include organ donation forms, for those who wish to do that.
In general, it's a good idea to use a form for your state. And you should get it properly witnessed, usually by two disinterested people. State rules are usually available with the form or online, but you may want to check with an attorney if you have doubts.
Also, if you spend a lot of time in another state -- for example, at a vacation home -- an attorney can advise you on whether your home state's form is likely to be recognized in your vacation state, or whether you should execute one for the second state as well. Attorneys say this is becoming less and less of a problem as state laws grow more uniform, but there can still be gaps.
But simple as they may seem on their face, these forms involve difficult emotional and intellectual questions that individuals executing them need to deal with. Experts recommend great care in the choices you make.
First, your agent should be someone who understands your views on medical treatment, death and dying, and who you are confident will follow your wishes. Living wills tend to be worded broadly, and almost always need interpretation in specific circumstances. Your agent will be the person to whom medical caregivers will turn for guidance, and the agent will have to do his or her best to decide as you yourself would have.
Note: In most states, the law allows physicians and hospitals to refuse to follow your directive for reasons of conscience. Some attorneys say they've never found this to be a problem, while others say they have. To be safe, if you figure you'll be treated at a certain hospital, it won't hurt to chat with the administrator to see whether there are objections to what you have in mind.
Second, before choosing a family member as your agent, discuss your plans with all your close relatives. Find out if there are differing views or objections. You of course want to choose an agent who agrees with you, but if there are family members who disagree, try to make it clear to them why you have chosen as you have. Family members may find it easier to acquiesce in a painful decision if they understand that it reflects your wishes.
"For people with more than one child the decision becomes much harder," said attorney Rhonda J. Macdonald of Vienna. Sometimes "people will name three children and say they must consult with each other and agree unanimously. That's begging [for] a little bit of trouble."
You don't want to create a situation in which the doctor is seeing one thing in your living will and hearing something else from your family. That's a recipe for having your living will disregarded despite legal requirements that it not be.
Also, most forms ask for a backup agent in case the primary one can't be contacted. Try to have as a backup someone who agrees with you and with the primary agent.
Third, living will forms allow you to make extensive modifications. You should discuss the form with your doctor -- so at a minimum he or she will know you have it -- and go over the treatments you'd want or not want, so you understand what you're specifying and you can make the guidance you leave as complete as possible.
An additional benefit of making these modifications, Cohn said, is the reassurance they provide to doctors and other health care providers that you've made a considered decision.
While medical directives can be executed without assistance of a lawyer, if you have family issues or a complicated situation, it's a good idea to consult an expert. And it's also wise to use this opportunity to clean up related estate-planning needs.
"I don't think in 20 years I've ever let anyone walk out of my office without four documents," Macdonald said -- a will, a revocable trust, durable power of attorney for financial matters and an advance medical directive.
And though most of those are normally associated with taxes and disposition of property, they make it much easier if you become incapacitated and need someone else to pay your bills and otherwise manage your affairs.