It is important to consider what kinds of medical treatment you would want or not want if you should become unable to make health care decisions for yourself. Combining a living will with a health care proxy is the best way to present “clear and convincing evidence” about your decisions.

A living will is a document that provides specific instructions about health care treatment. In a living will, you declare your wishes to accept or refuse life-sustaining treatment under certain circumstances. The living will often expresses general principles, such as the preference that treatment should be withheld if it would artificially prolong life. Other living wills list the specific kinds of treatment that are or are not acceptable, such as renal dialysis, chemotherapy, “do not resuscitate” orders or artificial nutrition and hydration (tube feeding).

Issues you should cover:

• artificial hydration and nutrition
• cardiac resuscitation and DNR orders
• mechanical respiration
• antibiotics
• pain medication
• AVOID ambiguous terms like “heroic measures” or “extraordinary treatments”

The health care proxy allows you to choose someone you trust to make medical treatment decisions on your behalf. With a health care proxy, your health care agent can interpret your wishes as medical circumstances change and can make decisions you could not have known would have to be made. You should limit the instructions you provide in the health care proxy itself – detailed instructions might unintentionally limit your agent’s ability to act in your best interest.

You can revoke your proxy or appoint a different one at any time by destroying the document and/or executing new one. You should notify your agent, doctor, lawyer, family and anyone else you gave a copy orally and in writing of your change or revocation.

Things to consider when choosing a health care agent:

Is your potential agent

• able to separate his/her own feelings form your own, respect your wishes even if they are different from what they used to be or if he/she thinks they are unusual or foolish?
• close by and willing/able to come now and in the future?
• willing to talk about your sensitive wishes and impending death; stay with you even when the going gets rough; allow you to talk about unfinished business, ask for forgiveness, offer apologies, share fears and sorrows?
• willing and able to work with health care providers?
• willing and able to handle potential conflict between family and friends?
• able to care for him/herself so that he/she is not drained by your illness?
• willing and able to handle responsibility, seek out information about your illness and what to expect?
• willing to acquaint him/herself with the social norms of your culture and religion?

Although the living will and health care proxy are separate legal documents and you do not need both documents, it is recommended that you consider completing both. Each document serves a specific purpose that together help provide clear and convincing evidence for a designated individual to carry out your preferred medical decisions.

Keep in mind that your health care proxy does not need to be the same person as the person to whom you give power of attorney or name the executor of your will. You can choose separate agents for each function. In fact, it is common that one person is appointed to take care of legal and financial affairs while a different person is appointed for health care decisions. You should consider the circumstances (financial, time, emotional and geographic) and their ability to carry out your wishes.

Common terms:

• The health care agent is the person you elect to make decisions about medical treatment when you are not able to do so.
• Advance health care directives and durable powers of attorney for health care are other common terms that refer to living wills and health care proxies.

Objectives/Goals of the Living Will and Health Care Proxy:

• Identify and document your health care directives so your loved ones can carry out your wishes.
• Prevent your family from the often overwhelming burden of medical bills for treatments you do not want.
• Enable your family to make arrangements for medical treatment you may need (ex. home care, physical therapy, dialysis, HIPPA authorization).
• Enable your family to communication with insurance companies (HIPPA authorization).
• Identify who you would like to bear the responsibility of communicating your wishes or making medical decisions if you can no longer do so.
• Document clearly your wishes concerning artificial nutrition/hydration, mechanical respiration and organ donation.