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Advance Directives

What you should know about preparing for your end-of-life care

En español | No one wants to think about what will happen if they have a serious illness or injury and can’t make their own health care decisions. But advance directives are as much for the living as they are for the dying — and the best time to have a conversation about these issues is when you’re not racing against time in a crisis.  Still, 70 percent of Americans never do.

We’ve made it easier. Here are questions and answers that will help you make sure your wishes about end-of-life care are granted.

Q: What is an advance directive?

A: The term refers to two documents: A living will and a health care proxy (also called a medical power of attorney.)

  • A living will outlines which medical procedures you want or don’t want if you’re unable to make medical decisions and end of life is near. For instance:  Do you want to be kept alive on a ventilator or feeding tube? Do you prefer to spend your last days in a hospice or at home? How do you feel about organ donation? If you’re confused or not sure, make an appointment with your physician, spiritual adviser or another health care professional to discuss various end-of-life situations. States have different rules governing when a living will can take effect.
  • A health care proxy allows you to appoint someone to make medical decisions for you if you are unable to make those decisions yourself.

Specifics about advance directives vary from state to state. You can print a free copy of your state’s advance directive forms.

Q: What qualities should I look for in a health care proxy?    

A: A health care proxy must be 18 or older, but the proxy doesn’t need to be a relative or someone with medical knowledge.

Look for someone you can trust and who can be there for you over any length of time. The person should be unwavering in his or her commitment to carry out your wishes — even if they are different from his or her own beliefs. A proxy should be mature and clearheaded during times of great stress; comfortable talking to doctors; and assertive enough to ask the right questions about treatments and prognosis.

States can have certain stipulations on who can’t be your health care proxy, such as an employee of a nursing home where you’re receiving treatment.

Q: What should I do if family members don’t agree with the choices I’ve made?

A: Advance directives can often lessen, even avoid, quarrels — and perhaps bring your family together at a difficult time. If you think your family may be in disagreement with the choices you’ve made in your advance directives, you can take some extra steps to help quell any uproar.

Make sure you inform all family members, in writing, who you’ve appointed to act on your behalf and why. Make it clear that if any uncertainties arise in interpreting your living will, your health care proxy, and no one else, is to make final decisions. A copy of your directives should be given to each of your relatives, as well as to your physicians and health care proxy. If you are later admitted to a hospital or nursing home, they get one, too.

Read AARP financial expert Jonathan Pond's The Cornerstone of an Estate Plan to learn more.

Q: Do advance directives ever expire?

An advance directive doesn’t expire, but you should review it periodically to make sure it continues to reflect your wishes. Remembering what we call the 5-Ds can help you do that:

Decade. Review your documents at least once a decade.

Death of a loved one. If the person you chose as your health care agent dies, you need to appoint a new agent as soon as possible.

Divorce. If you’re separated or divorced, you might want to reconsider your choice of a health care agent.

Diagnosis. Certain diagnoses may prompt you to rethink the types of care you would want.

Decline. Sometimes, as your health worsens, you might begin to feel differently about end-of-life situations than you did when you were younger.

Q: Is it necessary to take my ex-spouse off my advance directives?

A: In most states, an ex-spouse’s authority over your affairs is automatically revoked once you divorce. In others, you have to specially revoke it. In any case, if you don’t want your ex-spouse making these decisions, it’s always best to create a new document.

Q: Do I need a “letter of instruction” if I have a will?

A: A letter of instruction doesn’t have the legal punch of a will, but it gives you the chance to explain informally what you want to happen should you die. It can help avoid the “who-gets-Grandma’s-china” quarrels that can erupt after a will is made public.

A letter of instruction has three parts: In part one, you state your preferences about planning a funeral and the names of people who should be contacted. Part two covers financial matters — a list of your bank accounts as well as phone numbers for your employer, insurance agent or broker. In part three, you list people to whom you want to give something special — mementos, photo albums, jewelry and so on. Keep a copy of your letter of instruction with your advance directives.

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