Where Can I Find the Best End of Life Healthcare Directive???

January 25, 2022 3:10 PM

Just read a piece on Wired about Stewart Brands approach to end-of-life directive should he get Covid Got me to thinking about redoing my own directive. Does anyone know where I can find a distinctive, well written, legally sound directive on-line. Also, suggestions and advice of what to cover and be aware of in writing the directive and the directive itself would be appreciated
posted by goalyeehah to Law & Government (7 answers total)

A huge amount of this is state-specific (assuming you're in the United States)—for example, my state does not recognize advance directives (the information is certainly taken into consideration, but given no more weight than the judgment of a healthcare proxy), so there is no such thing as one that is "legally sound." By far the most important thing you can do regardless of your location is identify whom you want to make decisions on your behalf if you're incapacitated, make sure everyone in your family knows who that person is and is on board with it, and explain your wishes in detail to that person.

If you are at high risk for serious illness due to COVID-19 specifically (e.g. if you are immunocompromised, unvaccinated, etc), you will probably want to identify a secondary healthcare proxy who does not live in your household who is also aware of your wishes, because a unique challenge of the COVID pandemic has been that often the intended surrogate decision maker is themselves simultaneously gravely ill.

If you already have a serious underlying illness or medical frailty, POLST may be right for you—this is a standardized form that gives you options to indicate in advance which aspects of life-sustaining treatment you would desire or decline.

Certainly consulting a lawyer is one option; if you have a primary care physician, advance care planning is part of their practice and they can assist as well. If you live somewhere where there is one large health system with an integrated electronic health record or you have a pretty good idea of where you would be admitted if you got sick, having your wishes documented in advance in that system is your best bet (which would typically be accomplished either during hospitalization or via a visit with a physician who works in that system).
posted by telegraph at 4:24 PM on January 25, 2022 [2 favorites]

In the US this is state-specific as telegraph says. You can get this done as part of writing a will if you don't already have one. If you do already have one this could be part of an Advanced Healthcare Directive, I wasn't sure if you had a legally done one originally. I have one and it's part of my will but also stored online in the US Advanced Care Registry which my state partners with (so it's free for me). So I have a wallet card that says "Hey my info is accessible here" in case it comes up. That website has a list of forms that works in each state though they vary in completeness but would be a good starting point. Really the most important part is that whoever your immediate next of kin is (spouse or family member) is aware of your wishes, and is indicated as the person who can make medical decisions for you. I've definitely had friends who had family members who had this sort of thing as their wishes and who died instead of being on a ventilator. If that is your express wish, it's not only a decision you can make for yourself but also might give someone else a better chance who has a different outlook on their end-of-life plans. I think many people are making similar decisions.
posted by jessamyn at 5:08 PM on January 25, 2022 [1 favorite]

As others have said, this is unfortunately a state-by-state thing in the US.

However, the Five Wishes documents are recognized and enforceable in 42 states plus DC (provided they are properly completed and, in some cases, filed with the relevant organizations), so they could be a good starting point. They encourage you to treat it as a "process" rather than just a document, and go over your choices with family and close friends who might end up making decisions on your behalf in the event of severe illness or injury.

If you live in one of the 8 states that don't recognize Five Wishes, filling it in could still be a useful exercise in that it gives you something that you could take to someone local and say "I want this, but for our state".
posted by Kadin2048 at 6:36 PM on January 25, 2022 [2 favorites]

Response by poster: FWIW, I live in California.
posted by goalyeehah at 7:04 PM on January 25, 2022

Came here to suggest Five Wishes. I also used the Dementia Directive (dementia-directive.org)as an exercise for thinking through what I wanted to include in my advance directive, and have a copy of it filed alongside my official AD, to guide my POA if/when the time comes. The Go Wish card game is also very helpful in bringing up decisions you may not otherwise think of. There’s an online version here.

On preview, California has a great, easy to understand POA form with lots of space to customize. It is acceptable as long as it’s either notarized or signed by 2 in-involved witnesses (meaning, not your POA or other invested party).
posted by assenav at 7:10 PM on January 25, 2022 [4 favorites]

I will also suggest Five Wishes. They are a great organization. Also consider looking at it again in a few years, things change.
posted by dbmcd at 11:28 AM on January 26, 2022

Lifecare Directives llc who `mysteriously went out of business a few years ago had seriously comprehensive ones

Here is a web archive link to their free stuff which is still good....organized by state
https://web.archive.org/web/20171123221831/http://www.lifecaredirectives.com/statutory.html
posted by lalochezia at 8:43 PM on January 29, 2022