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Retirement Weekly: What happens if you’re incapacitated? How to get your advance directives in order.


There are some thorny tasks that everyone knows they should tackle. 

Every so often, they think, “I should do this.” 

Then they don’t.

Take advance directives. You’ve surely heard that you should think ahead and consider the type of healthcare and medical treatment you’d want if you become incapacitated.

If you don’t make these decisions now—and complete the necessary forms to state your wishes—someone else will make the decisions for you later. You know that, right?

For some of us, procrastination isn’t the only barrier to checking this off our to-do list. Confusion plays a role as well.

Just as it’s hard to track our immunizations (when did you get your last tetanus shot or pneumonia vaccine?), it’s tricky to recall when (or if) we filled out advance directives.

“People sometimes forget they filled out the forms,” said Scott Brown, president and chief executive of ADVault, a Richardson, Texas-based provider of advance care planning tools.

If you did sign them, where are they? Who knows about them? Are they easily accessible if you’re suddenly unable to convey your wishes?

Advance directives typically consist of a living will and a power of attorney for healthcare. Each state has its own statutory advance directive form. To find your state’s legal form, use the menu bar at PREPARE for Your Care.

Because these state forms are legal documents, the wording can be dense and formal. The Five Wishes advance directive, which meets legal requirements in most states, is written in plain English.

After completing the proper forms, you might think you’re all set. You’re not. The forms won’t magically plop into the hands of medical providers as they’re weighing whether to, say, resuscitate you during a medical emergency or administer artificial feeding or hydration.

“Most people adopt a ‘set it and forget it’ mentality,” said Scott Halpern, M.D., director of the University of Pennsylvania’s Palliative and Advanced Illness Research (PAIR) Center. “They may never revisit it. That’s why advance directives tend to not have an impact because they get lost” and complacency sets in.

Halpern suggests that individuals initiate conversations with both their physician and their family and close friends about their “concerns, values, goals and fears” as they relate to advance care planning. For example, tell them what forms of medical intervention you’d find acceptable and unacceptable—and what level of life-sustaining treatment you’d like if you’re deemed permanently unconscious.

J. Randall Curtis, M.D., is director of the Cambia Palliative Care Center of Excellence at University of Washington School of Medicine. He’s also been diagnosed with ALS.

“I’ve completed a living will and a durable power of attorney,” he said. “But I think much more important than these documents is having in-depth and ongoing discussions with my wife, closest friends and my palliative care physician to make sure they understand my values and goals and my current views of ‘states worse than death.’”

When sharing your end-of-life wishes with your doctor, it’s likely that your clinician will enter your comments into your electronic health record. Once that happens, any other healthcare provider with access to those records (such as a hospital system) can retrieve them.

What if you’ve completed multiple forms over time? Perhaps an estate-planning attorney or doctor prompted you to fill out advance directives years ago. A decade later, a financial adviser urged you to do so. Now you have duplicative forms that may contradict one another. Laws vary by state when it comes to which end-of-life wishes take precedence.

“It’s usually last-in-time,” Brown said. “The most recent document” holds sway.

To be safe, review your advance care plan every year or two. Changes in your health, personal relationships or attitude about life-sustaining treatment can lead you to change your directives.

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