Dying With Dignity With a Living Will

-Dr. Rao Musunuru

     It has been said many times that one can not escape two things in life – taxes and death.  Though one can properly prepare for both of them.

     April 15th has been the last day to pay yearly incomes tax, since 1955.  This year, it will be April 18th (15th being a public holiday in District of Columbia, Emancipation Day).

     ‘Last will’ and ‘living will’ come to mind when one thinks of the second inevitable thing in life, the death.  April 16th is designated ‘National Healthcare Decision’s Day’ to encourage people of all ages to execute an “advance health care directive”.

     Unlike a ‘last will and testament’, which comes into effect after your death and deals with the disposition of your assets according to your wishes, a ‘living will’ comes into effect while you are still alive but rendered incompetent to make your own health care decisions.

     A person can become incapacitated unexpectedly at any age, for various reasons like a critical injury, an acute catastrophic illness or complication of a chronic disease.

     The personal and religious philosophy and preferences regarding life, illness and death vary so drastically from person to person.  Taking one’s own life is illegal but refusing treatment by a competent person is not.

     Recently one morning, I saw two elderly patients with a similar condition – a very weak heart causing heart failure.  I recommended an implantable defibrillator, which is the current standard to prevent sudden death, for both of them.  The first patient looked me straight in the eyes and said without any hesitation – “Let me understand this.  At my age and with all my medical problems, I have a chance to die suddenly and peacefully and you are proposing to deny me that opportunity?”.  The second patient also looked me straight in the eyes and said without any hesitation – “Did I hear you right?  You have a way to prevent me from dying suddenly and you are wasting time discussing it.”. 

     A ‘living will’ records your end-of-life wishes for medical treatment, in case you are no longer able to speak for yourself, typically dealing with life prolonging measures such as artificial ventilation, tube feeding, and cardio-pulmonary resuscitation.

     A ‘living will’ is often combined with a ‘health care proxy’ (sometimes referred to as a representative, advocate, surrogate, agent or attorney-in-fact) named through a “durable power of attorney for health care”, who can evaluate and decide on a tailored treatment option for you, if you do not want to be too specific about your end-of-life treatment at this point.  A ‘health care proxy’ does not have to be a legal member of your family.  The living will and the health care proxy together make up what is called an “Advance Health Care Directive”.

     Most people do not see the need for a ‘last will’ or a ‘living will’, as they are too young to worry about death.  I see a lot of young people with most vulnerable dependants die everyday, for many reasons.  That is exactly when the planning counts the most.  The names Karen Quinlan, Nancy Cruzan and Teri Schiavo should remind us of the disastrous unfortunate consequences of unforeseen and unprepared circumstances. 

     A ‘living will’ is a legal document, promoted by Florida statutes chapter 765.  There is no specific prescribed form and you do not need an attorney’s help.  Sample forms can be obtained from various sources including hospitals, physician offices, many other health care organizations, attorneys and many other social institutions.  The laws vary slightly from state to state, even though there is much reciprocation.

     A written ‘living will’ needs two witnesses (no notary needed) and one of them cannot be a spouse or a blood relative.  A ‘living will’ can be oral, as long as there is “clear and convincing evidence”.  A ‘living will’ does not expire and can be updated any number of times.

     If you do not have a designated ‘health care proxy’ before you become incapacitated (as determined by the physicians) the decision-makers in the order of priority will be previously appointed guardian, spouse, majority of available adult children, parent, adult siblings, adult relative, close friend or a licensed social worker.  Your physician is not legally allowed to be your health care surrogate.

     An existing ‘health care advance directive’ cannot do any good, unless it is made available to your physicians by yourself or through your close relatives, chosen and consenting health care surrogate, attorney or your spiritual leader.

     We all want to keep on living.  But willing to live is not the same as living willingly.  Futile attempts at prolonging life for a few more days or weeks in the absence of a clear direction in advance from the patient, in case of terminal or irreversible situation, will only add to the physical suffering of the patient and the psychological torture for the family.

     Life is too precious and needs to be saved at any cost.  However, living well and leaving at the right time is the best gift one can give to the loving family.

A ‘living will’ goes a long way to accomplish just that!

Note: Dr. Rao Musunuru, a practicing cardiologist, is the recipient of Tampa Bay Business Journal’s 2007 Health Care Heroes, Lifetime achievement award.

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