By Samantha Weyrauch Davis
For EMTS and paramedics, end-of-life care brings to mind hospice or do-not-resuscitate directives – DNRs. But what about living wills?
What is a living will? Sometimes also called an advance directive, medical directive or personal directive, a living will is a legal document that explains how you want medical decisions about you to be made if you cannot make the decisions yourself. An advance directive lets your healthcare team and loved ones know what kind of healthcare you want, or who you want to make decisions for you when you can’t.
A living will can help you think ahead of time about what kind of care you want – this can include medical treatment, hydration and nutrition in various circumstances. These medical decisions may include special actions or emergency care from your healthcare team. Living wills only apply to healthcare decisions and not financial or money matters.
The nature of fire and EMS presents inherent increased risk factors of illness and mortality. As such, living wills should not be overlooked for your own healthcare intentions to be carried out under certain circumstances. Making sure that your own estate plan is established and your healthcare wishes are clear gains a whole new importance in current times.
How to set up a living will
The laws pertaining to living wills are different from state to state, so it is important that you have a living will that is complaint with your state and filled out correctly and completely. Reach out to your healthcare provider or your attorney about obtaining a living will and filling it out when you are healthy, in case you become too ill or are unable to make medical decisions for yourself in the future.
It is critical that wishes pertaining to end-of-life decision making are documented clearly in valid legal documents and that persons are designated to effectively carry out those wishes.
As first responders, you know it is not unusual to be confronted with confusing documents, or with documents that contradict the wishes expressed by the surrogate decision maker. The situation is made even more difficult when the surrogate decision maker is absent, or when patients have never discussed their wishes for end‐life care with their family. As professionals, this is neither ideal for those we treat, nor for ourselves. We have the ability to help ensure that if we are in such health circumstances, our wishes will be honored.
Honoring living wills
If a patient is unable to communicate regarding end-of-life decision making, living wills should guide care. If there is no living will, families may be asked about the patient wishes. States typically designate spouses as proxy decision makers, followed by children and siblings, where appropriate.
Importantly, some states make a clear distinction between the authority of the healthcare power of attorney versus the next‐of‐kin to make decisions regarding withholding and withdrawing care.
Parents or guardians serve as decision makers for minors, although teens or “mature minors” may possess legal standing for medical decision making in some circumstances.
Making such difficult decisions at the bedside is never ideal. Patients and families may not agree regarding the application of living wills to clinical scenarios, for example, trauma, surgery or other clinical settings. This underscores the importance of a discussion to ascertain the accuracy of living wills, and the appropriate application to the clinical setting.
It is important to ascertain the patient wishes as expressed to or known by the family, not personal wishes of family members. At times, there may be disagreement about the best medical treatment and level of invasive and aggressive medical care at the end of life. When there is a lack of agreement, communication should aim to develop consensus about the best course of action that is consistent with patient goals and values. However, time can be of the essence limiting these efforts.
Clearly outlining your wishes and communicating them with your family is one of the most important things you can do for yourself and your family. A living will is part of an overall estate plan that should be established to fit your circumstances and give peace of mind for the future.
About the author
Samantha Weyrauch Davis is a shareholder at Hall Estill Law Firm in Tulsa, Oklahoma, concentrating her practice on trust and estate planning in Oklahoma and Texas.