The Living Will and
Advanced Directive
Today I would like to talk about something that most of us really don't want to talk about, including me. But I feel I would be unfair to any family and caregivers that I may have if I don't do something about this ahead of time.

I am talking about Advanced Directives, Living Wills, and Durable Power of Medical Attorney.
I know that I am probably not the only one out there that has no idea where to start looking for good information on this and trying to find a good place to start! First I would like to say that these documents are not just for the chronically or terminally ill. It is a good idea for everyone to have one and they can be updated as needed. What if you should get in a car accident or that the piano falls out of 10 story building on top of you! No matter where you are in life they are a guide for your family and/or caregivers to follow and it takes the burden of decision making off of them and will reassure you that your wishes will be carried out.

All 50 states and the District of Columbia have laws recognizing the use of advance directives. Most state will honor another states advance directives as well. So you know that even if you are out of town and something happens your wishes will be followed.

What are Advanced Directives?

There are two types of Advanced Directives that we can deal with for Medical purposes.
They are the Living Will and the Durable Power of Medical Attorney.
What are the differences between them?
A Living Will spells out the types of medical treatments and life sustaining measures that you do or don't want - ventilators, DNR and tube feedings are a couple of examples of these.
A Medical Power of Attorney is a legal document that designates an individual to help make medical decisions on your behalf in the event you are unable to. This differs from a Power of Attorney because it does not deal with financial transactions only your Medical.

Will you need a lawyer?

From what I have found it is not a bad idea to have a lawyer look it over especially if the form that you fill out does not meet your needs. Different states have different laws, here are three links where you can find the forms from different states. Also from what I have read the most states and hospitals will honor Living Wills and Advance Directives from other states.
http://dying.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.uslivingwillregistry.com%2F http://www.alwr.com/
 http://www.partnershipforcaring.org/Advance/documents_set.html

Ok now that we have the forms what comes next?
 Most of the sites that I have gone to advise talking this over with family and caregivers ahead of time. It is not always easy to talk about but it is something that needs to be done for everyone's piece of mind on long run. There has been more than one family torn apart because the family could not agree on type of care and quality of life that a loved one wanted. This will help your family come to terms with what you want and take the hard decisions out of their hands.

Then we need to decide who would be best to carry out our wishes, and we should not chose out of guilt or will this one be upset because that one was chosen. You need to pick the one who you think can and will follow your wishes!

Now comes the very hardest part IMHO - What do we want to do in different cases?
First rest assured that you can check over these documents and change them at any time as long as you are of "sound mind" -  it is the same criteria as writing a will. You should look over and make changes as your situation changes because what you might want done today may not be what you want or need 20 years from now. It is amazing how our personal opinion of what is "quality life" changes with the years!

So when we might say we don't want a vent ever, we need to weigh in all of the facts. What if you are still early enough with your COPD that a ventilator for a short period of time will let you lead a fairly normal lifestyle later.
Or are you at the point a vent will "just" keep you going?
These are hard decisions to make and it is best if you discuss them with your family and your representatives that you have named in your paper work.
After doing some extensive research what IMHO is the best guide for this was found in a round about way. It is a downloadable/printable guide to making an Advanced Directive. It is too long to copy here there are 10 different tools to look at , but to get your own copy you can go to http://www.abanet.org/elderly/toolkit/home.html
It is written in easy to understand language and covers 10 different aspects of writing your advanced directive.

Now we know what we want, we have written up our living will, advanced directive, what do we do with them?
 
It is advisable to have a copy registered at the hospital you go to. You can also have a copy put in your medical records in some places. You can keep a copy in a safety deposit box, have one on file with your doctor or carry one in your wallet with your insurance cards etc. Leave a copy with your Medical Emergency Info that we are supposed to keep on refrigerator.

This should do it if you know you will be taken to the hospital you normally go. But if the closest hospital is not your normal one or if you travel you may want to register with one of these two Living Will Registries. That way they can be gotten wherever you are at.

This one looks like it may cost a small fee to register, but I have not gotten far enough to want to do that yet! http://www.alwr.com/

And this one is a free service. http://www.uslivingwillregistry.com/

You will be issued a card with either of these sites and your medical care team can access your Directive and Living Will with the number on the card. You carry the card with you just like you do your insurance/medicare cards. Besides the aforementioned sites, I have used these sites for reference.
 http://www.mayoclinic.com/invoke.cfm?objectid=83E7580F-6506-4D06-B9424AC6ED1CA79A http://dying.about.com/cs/livingwills/index.htm?terms=living%20wills