However, making end-of-life medical decisions for another person is never a right, even for married couples, unless one person has given that authority to a proxy by signing a Health Care Power of Attorney (HCPOA) form—or has a legal Guardian. Without a signed and witnessed HCPOA form, the Surrogate Law provides for a spouse then family first as decision maker when an individual cannot speak for their self. Under the law, The Surrogate is unable to make decisions regarding withholding or withdrawing treatment that would influence end-of-life. That was the legal issue of the Terri Schiavo case. In such situations, legal guardianship—as happened to Conrad and Atkins and Kowlaski and Thompson–can be acquired by the Surrogate through a costly legal process. Legal Guardianship allows the Guardian to make ALL decisions regarding the life of the person, including where they live, with whom, how they are cared for and where their money goes—no matter what the person “guarded” may wish for.

Today, as many as 85% of the people who die in hospitals do so after a decision to withhold or withdraw treatment has been made. When an individual is in the Intensive Care Unit, on life-support with tubes everywhere and unable to make choices for themselves, someone is called upon to make life or death decisions.

No, having Advance Directives is not a guarantee that your wishes will be honored, but it is the best insurance you have of exerting some control over your life—and especially your death. Advance Health Care Directives include A Health Care Power of Attorney (HCPOA) form and a Living Will.

With the HCPOA you designate one person that you trust to be your Health Care Proxy to speak for you should you be unable to do so, along with one or two subsequent persons in case the designated proxy is unable or unwilling to take the responsibility when the time comes. Your choices can be changed as frequently as you wish for as long as you are able to make decisions for yourself. In the last ten years, I have designated three different people as my proxy. Should I continue to live, I may change my selections many more times. Free statutory Health Care Powers of Attorney forms for every state are available at http://www.caringinfo.com. If you own homes in more than one state, it is to your benefit to complete a form for each s laws vary from state to state.

You must select the person you trust to make end-of-life decisions for you carefully. A recent study showed that one-third of married people who completed a HCPOA did not choose their spouse because they did not want the spouse to have to have to make such decisions or they believed the spouse would be unable to do so. Consider what you are asking a loved one to do for you: pull the plug or order treatments that will prolong your death and potentially cause great suffering.

Once you have chosen the person to be your voice, your proxy with the medical establishment, you need to talk with them about your wishes so you can be secure they are willing to accept this grave responsibility before you put their name on your HCPOA document. I hold the HCPOA for two friends. I believe this is an honor and a privilege. We have had lengthy discussions regarding their wishes, and I have agreed to do everything in my power to honor those wishes. You don’t need an attorney to complete a HCPOA, merely two witnesses and preferable people who know you.

Giving your Proxy a completed Living Will tells them in detail what kind of care you want him/her to authorize your medical caregivers to provide should you (a) be unable to speak for yourself and (b) be in a terminal condition as determined by medical professionals. By completing a Living Will, you are giving directives to your proxy in advance of need. There are many living will forms. The Five Wishes is comprehensive, caring and legal in almost every state. It is available for a nominal cost at http://www.agingwithdignity.org. In addition to telling my HCPOA that I do not want my death prolonged by artificial technologies for feeding and breathing, I want to be cared for by hospice, I want chocolate ice cream in my mouth, socks on my feet, no television on anywhere near me—and please tweeze my chin hairs! It’s all there on my Five Wishes.

After you have selected someone to trust with your health care decisions, discussed your wishes with him/her and your subordinates, then complete a HCPOA form and have it properly signed and witnessed by people who know you. You do not need an attorney for this. Next, distribute copies to EVERYONE who would be involved in your care were you unable to speak for yourself: your proxy, subordinates, doctor, lawyer, partner/spouse, parents, and siblings. If you complete a Living Will at the same time, distribute copies of it as well—but don’t wait to distribute the HCPOA if you’re not ready to complete a living will.

Selecting a Health Care Proxy is the most important decision you make regarding your ultimate medical care, according to William Colby in his book Unplugged. Whether or not you complete the form, once you have chosen that person, create opportunities to talk with him/her and your loved ones about those decisions. Had Terri Schiavo done that, everyone would have known rather than guessed whether or not she wanted to be on life support in a vegetative state. Use news stories or the experience of others as teaching moments. Like, “Mom, here’s a story about …. If that ever happens to me, I want….”

Both you and your Proxy should carry a signed HCPOA card in your wallet and your glove compartment (included in the Five Wishes form). Your proxy and the subordinates should have his/her copy of that form where it is available at a moment’s notice. When you distribute the forms I strongly suggest having a little tea or cocktail party for all of the people who would be involved in your end-of-life care to celebrate the freedom under which you can now live. To celebrate the achievement of considering your own death. Perhaps make it a group HCPOA party!

Remember that many of the people you love will die before you. One may consider you the person they trust with their health care decisions. How can s/he expect you to serve in time of need without having a conversation about their wishes? If you are not designated Proxy, you will need to support the person who is. When that critical time comes, the circle that forms is generally small. Make it easy for your loved ones: prepare.

Right now, the worst part of living in America is dying here. We make so few provisions to make dying a positive experience for everyone involved, the person dying, their loved ones (if they have any), to the people who care for our dying. Even with increased use of hospice, one-third of hospice patients receive that specialized care for less than one week, many for merely hours. Something has to change and it has to start with each of us being willing to engage in a life-long process of considering our own deaths, talking about it and taking some action to prepare. In my experience, doing so helps us live more consciously, compassionately and freely. After all, what benefit does any one reap by not considering your own death? What suffering do you offer yourself and your loved ones when you choose not to prepare in all the ways you can?

ASK YOURSELF THESE QUESTIONS:
In the event that you had a medical emergency today, who is the person(s), you would want to be called to be with you at the hospital?
In the event that you were unconscious or too sick to make decisions about your medical care, who is the person you would trust to make health care decisions for you—even decisions that may end your life?
Which loved ones would such an event impact and in what ways?
Have you prepared your loved ones for such a medical emergency?
Are you prepared to make end-of-life health care decisions for your loved ones?
Do you know what end-of-life choices your loved ones would make for themselves—and could you honor those choices?
What would happen if you died today?
Who will your death impact most and in what ways?
Have you prepared your loved ones for your eventual death?
Have you prepared yourself?
What’s stopping you?

Just do it—and be free from the burden of “what if?”

Thank you.