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Guest column | Dr. Rao Musunuru

Living will makes your wishes known when you can't

It has been said many times that no one can escape two things in life: taxes and death. But one can properly prepare for both of them.

April 15 has been the last day to pay yearly income tax since 1955. This year, it will be April 18 because April 15 is a public holiday in the District of Columbia.

Wills and living wills come to mind when one thinks of the second inevitable thing: death. April 16 is National Healthcare Decisions Day, which encourages 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 incompetent to make your own health care decisions. 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 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 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 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.

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, most with vulnerable dependants, die every day, for many reasons. That is exactly when 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 Chapter 765 of the Florida Statutes. There is no specific prescribed form and you do not need an attorney's help. Sample forms can be obtained from hospitals, physician offices, health care organizations, attorneys and many other social institutions. 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.

Dr. Rao Musunuru is a practicing cardiologist in Bayonet Point.

Living will makes your wishes known when you can't 04/13/11 [Last modified: Wednesday, April 13, 2011 6:30pm]
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