Jan 26, 2023
End of life planning is not only for the elderly
For many people, COVID-19 turned some key assumptions about healthcare upside down. For example, many people may have faced needing extraordinary medical care, such as going on a ventilator, well before the age they may have anticipated. It also highlighted how many people—especially the young—do not have basic estate planning documents in place.
Estate planning is often thought of as pertaining to wills and financial matters. But it also includes documents that govern how medical decisions should be made if you are incapacitated and unable to make them for yourself.
At a minimum, we think everyone should complete a healthcare power of attorney that appoints a representative (usually a friend or family member) to make medical decisions on their behalf. This document typically also includes directions about the type of care you want to receive if you are ever incapacitated.
Those who have more specific wishes about the type of care they do—or do not—wish to receive toward the end of their life should consider creating additional estate documents.
Why have a living will?
A living will, more precisely known as a “Declaration of a Desire for a Natural Death,” is a type of advance directive regarding your preferences for medical care at the end of your life.1 A living will is a written legal instruction that layers on top of a healthcare power of attorney document. It informs your doctors that if you are incurably ill, you do not wish to prolong your life by artificial or extraordinary means. It can also specify if and when you want to use various medical treatments to keep you alive, such as a ventilator or tube feeding.2
Having your wishes spelled out like this is not just for your own benefit. It can also provide clarity to your loved ones and prevent disagreements at a time when they are being forced to make a difficult “life or death” decision.
How do I create and use a living will?
Since it is a legal document, it can be helpful to have an estate attorney prepare your living will. However, your state may have standard forms or other options available free of cost.
A living will applies in a hospital or care facility.3 Plan to share your document with your doctor and healthcare agents. It can also be helpful to discuss your wishes with your loved ones, so they are prepared when the time comes.
The scope of a living will is narrow—it applies only to end-of-life decisions.4 And, as COVID-19 has shown us, even young and healthy individuals can find themselves incapacitated, attached to a ventilator and potentially needing to provide such a directive. For that reason, don’t feel you must wait until you have a terminal illness to create a living will— we suggest that you plan for unexpected events by writing it now. In our view, you should also plan to update it as your circumstances and feelings may change.
Is there anything else I should consider?
A “DNR” (Do Not Resuscitate) order has a narrower focus—it directs people not to start CPR, which is the treatment you receive when your blood flow or breathing stops, if the situation arises. A DNR applies both inside and outside of a medical facility.5
Who is this document appropriate for?
A DNR order is typically appropriate for someone who is near the end of their life or who has an illness that will not improve. These patients may feel that any resuscitation efforts are simply prolonging the inevitable. For that reason, DNR orders are often a part of hospice planning.6
If this applies to you, consider talking to your doctor about expectations for your prognosis and the pros and cons of CPR. It can also be helpful to discuss your thoughts with your family and loved ones.
How do I create a DNR order?
If you determine that you do not want to receive CPR, talk to your doctor about a DNR order. Your doctor should write the DNR order in your medical record and assist you in gathering the applicable documents to keep in your home and/or on your person. A popular place to display any DNR orders is on your fridge—paramedics are typically trained to look here when responding to house calls.7 It is also advisable to carry a copy with you, such as in your wallet.
To ensure that your wishes are followed, update your living will and inform your healthcare agent and family of this decision. Note that your family may not override this decision if your doctor has already written a DNR order at your request.8
What if I change my mind?
If you have a DNR order, you always have the right to change your mind and request lifesaving measures. If you do, talk with your doctor and family/caregivers about your decision immediately. You will need to update any documents you prepared that include the DNR order.9
The specifications around creating legally binding documents, including power of attorney forms and advance directives, differ by state. We encourage you to work with a team that includes an estate attorney and a financial advisor to review your documents and ensure they are comprehensive and accurately reflect your wishes.
And finally, your feelings may change, and with that, your directions about what type of care you’d like to receive at the end of life. Plan to regularly review and communicate any changes to your doctor and caregivers. This planning will ensure you live out your life according to your wishes and will provide comfort and reassurance to your loved ones.
1 https://www.alllaw.com/articles/wills_and_trusts/article7.asp
2 https://www.forbes.com/health/healthy-aging/what-is-a-living-will
3 https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/living-wills/art-20046303
4 https://www.forbes.com/health/healthy-aging/what-is-a-living-will
5 https://medlineplus.gov/ency/patientinstructions/000473.htm
6 https://medlineplus.gov/ency/patientinstructions/000473.htm
7 https://seniorcareadvice.com/health-well-being/health-safety/the-do-not-resuscitate-order-is-on-the-fridge-how-and-why-you-should-prepare-now-for-an-emergency.htm
8 https://medlineplus.gov/ency/patientinstructions/000473.htm
9 https://trustandwill.com/learn/can-a-dnr-be-revoked-by-family
ABOUT THE AUTHOR
Eileen Stevens
As an Associate Wealth Advisor at the firm, Eileen is responsible for conducting financial planning analyses, formulating investment recommendations, and assisting the Wealth Advisors in developing and presenting strategies to help clients in reaching their financial goals. Eileen graduated from Virginia Tech with a Bachelor of Science in Finance and concentration in Financial Planning. Prior to joining the firm in 2020, Eileen spent five years at a wealth management firm in Columbia, South Carolina, specializing in closely held family businesses. She earned the CFP® designation in 2016. Eileen has volunteered as an instructor and mentor with Rock the Street, Wall Street, a nonprofit organization aimed to equip high-school girls with the skills to succeed financially and pursue a career in mathematics. She also serves on the Genesis Committee for the National Association of Personal Financial Advisors (NAPFA), sharing the finance career path with students and engaging young planners in a peer-to-peer networking group.
In her free time, Eileen enjoys traveling, taking cooking classes, and learning French.
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