Dear NP

Dear NP,

During my recent hospital admission, the nurse asked if I have an advance directive or a living will. I am only 55 years old. What are these documents, and are they necessary at my age? S. S.

Dear S. S.,

Aging is something that will happen to all of us, eventually. It’s scary to think about, but this is why it’s so important to plan ahead, whether it’s for you or a loved one.

Unfortunately, according to the CDC, many people don’t plan ahead – according to the CDC, up to 70% of Americans do not have an advance care plan. Fifty-five may feel a bit early to start planning, but the whole point is to get the process started now before anything happens.

To get to your question – an advance directive, also called an advance healthcare directive or a living will, is a written, legal document that specifies how a person would like medical decisions to be made if they can no longer make those decisions for themselves. While some countries only treat advance directives as legally persuasive documents, meaning the actual course of action is decided case-by-case with the advance directive taken into consideration, in others, the directive itself is legally binding.

In the United States, advance directives are legally binding, and the decisions you make now will still apply years from now, even if you’re no longer able to speak or advocate for yourself.

It’s essential to make an advance directive while you’re still healthy so that you can be confident your wishes are followed as you age. However, another important consideration is the security an advance directive can provide your family.

You may be thinking, “My family loves me. Of course, they will always want the best for me – why do I need a plan to tell them what to do?” But the reality of the situation is much more complicated. Just because your family loves you does not mean they can read your mind.

If you become old and ill enough that you can’t articulate your needs, an advance care plan can help give your family some peace of mind. Following the plan will give your family confidence that they have “done the right thing” by you.

An advance directive will also provide your healthcare providers with information about important care decisions, such as whether you would like to be put on life support if your condition deteriorates to the point where it appears you have little to no hope of recovery.

End-of-life health care is a challenging issue to think about, and it may be difficult to discuss with your family, but it’s a critical decision. In some states, the law may make it difficult or impossible for health care providers or family to decide to remove life support without an advance directive in place.

Some people may need to make an advance care plan earlier than others. If you or a family member suffer from a chronic illness, it’s essential to have these conversations now. Unfortunately, chronic diseases frequently do not get better, and it’s much better to talk about it while you’re still in relatively good health than waiting for catastrophe to strike.

Once you have decided to make a living will, the first step is to talk to your family, especially those likely to be participants in your care. This conversation won’t be the most comfortable talk you’ll ever have, but it will make things much better, in the long run, to be on the same page. Some other factors you’ll need to think about include:

Do you want all available pain relief options, even if these may have side effects or may shorten your life?

If you decide you would like life support measures, which types? Feeding tubes, CPR and ventilators are a few examples of care options for the end of life.

How do you feel about organ donation?

What funeral arrangements would you like? Burial is the most common option, but there is cremation or even donating your body to medical research.

After you’ve made your choices, put them in writing. In the US, it’s best to work with a lawyer if possible, who may be able to help with other estate-planning documents such as a will and testament. A living will can be prepared without a lawyer, but make sure to check the requirements in your state to make sure what you prepare is legally binding when the time comes.

It can be scary to think about the end of your life or that of a loved one, but one way to make it less scary is with a little planning. Making an advance healthcare plan now can give you and your family the peace of mind you need to focus on living life while you are still here to get the most out of it.

Dr. Wesley Davis is an Emergency Nurse Practitioner at Crook County Medical Services District and Coordinator of the Family and Emergency Nurse Practitioner program at the University of South Alabama. He encourages readers to send their questions to [email protected]