The Four Essentials of End-of-Life Planning: Are You Good to Go?

Portrait from a senior man. Picture made in a studio

Try to imagine that you have suddenly lost the ability to speak for yourself due to a serious accident or because you're at the end of life. Would your spouse, partner, or family know what medical treatments you want or don't want? Have you named someone to be your health care agent? If you are seriously ill or very elderly and want to avoid having CPR, have you and your physician signed a Physician Orders for Life-Sustaining Treatment form (POLST)?

After you die, rather than being left wondering whether or not they made the right choices, will your loved ones instead have the peace of mind and comfort provided from knowing that they honored your wishes?

If the answer to these questions isn't "yes," or you're not sure, then you may not be "good to go." To ensure that your choices for medical and end-of-life care are documented, available, understood, and honored, consider these four essentials of end-of-life planning.

  1. Document your wishes using advance directives—a living will and Durable Power of Attorney (DPOA) for Health Care. A living will (also known as a Health Care Directive) documents your choices about medical care that you do or don't want. A DPOA for Health Care allows you to designate someone, known as a health care agent, to make medical decisions for you. Neither of these documents takes effect until you're unable to speak for yourself.

    • Compassion & Choices of Washington offers a free advance directive packet that sets a new standard for advance directives in Washington and combines a living will and Durable Power of Attorney for Health Care into one document. Combining two documents into one makes it less likely that one or the other will be misplaced.
    • To see the pros and cons of commonly used advance directives in Washington, click here.
    • Designating a primary health care agent and an alternate agent (in case the primary agent is unavailable) with a DPOA for Health Care is highly recommended.
    • Generally speaking, it is not necessary to have an attorney prepare these documents.
    • Notarization is not required in Washington. A living will must be witnessed by two people. Although the DPOA for Health Care only requires the signature of the person making the document, it is usually witnessed by two people.
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    If you are seriously ill or a very frail, elderly person who wouldn't be surprised to need emergency medical services, consider documenting your wishes for emergency medical care with a Physician Orders for Life-Sustaining Treatment form. Unfortunately, advance directives cannot be relied upon in emergency medical situations. A POLST is a nonhospital medical order signed by the patient and his or her physician that greatly improves your chances of getting the medical care you do or don't want.
    • The POLST must be posted where emergency medical service providers can see it. Posting it on the refrigerator is recommended.
    • POLST remains with you if you are transported between home and hospital or between care settings like a nursing home and a hospital. Make sure your family members or caregivers know that your POLST is supposed to travel with you.
    • EMS honors only the POLST. Bracelets, necklaces, and even tattoos that say "No CPR" are not honored.
    • No witnessing or notarization is required.
    • Click here to download the POLST information brochure. Click here to request that a POLST be snail-mailed to you (POLST is a large, bright green card and cannot be downloaded or emailed.)
  3. Advance directives or POLST are useless if they aren't available when they're needed.

    • Unlike most legal documents, copies of advance directives and POLST are just as valid as the original.
    • Keep the original signed documents in a secure but accessible place. Do not give the original documents to your attorney or put them in a safe deposit box or any other security box that would keep others from having access to them in the event of an emergency. Your health care agents or other close family and friends should know exactly where to look for your document.
    • Make photocopies of the signed originals and give them to your health care agents, doctors, lawyer, family, close friends, clergy, and anyone else who might become involved in your health care.
    • Make sure your copies of your advance directives (and POLST, if you have one) have been placed in your medical records.
    • If you enter a nursing home or hospital, admission staff may offer you other advance directives. Don't fill out these forms. Do provide them with copies of yours.
    • If you are in a gay or lesbian marriage and travel outside of Washington, carrying a DPOA for Health Care that designates your spouse as your health care agent is particularly important. Without it, you could be denied access to your spouse in an emergency room or prevented from visiting her or him in a hospital.
    • To ensure documents are on hand, many couples carry copies of their advance directives in the glove box of their vehicles or in a compartment in their suitcases.
  4. Perhaps the most important part of the advance planning process is communicating your wishes to the people who will be involved.

    • Discuss your wishes concerning medical treatment with your health care agents, doctors, clergy, family, and close friends, particularly if your medical condition changes.
    • After your discussions with your health care agents, physicians, or family, consider taking the Health Care Decisions IQ Test. This is a great tool to find out how well you have communicated your wishes.
    • Try to get a commitment from your family and medical providers to honor your wishes. If your doctor will not agree to honor your wishes, you may want to find a new doctor. If a family member does not agree with your choices, try to get her or him to agree not to interfere.
    • Make clear to other family members that your health care agent will have final authority to act on your behalf.
    • For more advice about communicating your end-of-life wishes, see Talking To Your Family About Dying and Talking To Your Doctor About Dying.

If you have any questions about this article, advance directives, POLST, or your end-of-life choices, contact Compassion & Choices of Washington at 206-256-1636 (toll-free 877-222-2816) or info@CompassionWA.org.

Contributor Robb Miller has been the executive director of Compassion & Choices of Washington (C&C) and on the steering committee of the Washington End of Life Consensus Coalition since 2000. He is the author of C&C's Advance Directive and a coauthor of C&C's Alzheimer's Disease and Dementia Mental Health Advance Directive. Robb was one of the leaders of, and key spokespersons for, the I-1000 Coalition that passed Initiative 1000, the Washington Death With Dignity Act, in November 2009.