643f3c7031a1d4ba_640_doctorDuring my initial consultation with clients, I always discuss the various documents that should be part of a comprehensive estate plan. As I explain the purpose of each document I find that the Directive to Physicians, also known as a Living Will, generates the most discussion. It’s also the document clients have the most difficulty signing.

The reason this document creates such a “flurry” of discussion is that it forces you to consider that one day you may be hospitalized in an unconscious state with no hope of recovery. And, it puts you in the position of deciding before that happens how and when to end your life. Thinking about issues like this can and should make you think deeply and ask a lot of questions.

What Are Your End Of Life Wishes?

Most people will agree that they don’t want artificial means to be use to keep them alive if they are significantly brain damaged and won’t be able to live a meaningful life. But, in reality, the circumstances are not always clearly black and white. Let me use two examples that illustrate the complexities of the issues.

The Case of Shellie Eldredge

The first case scenario involves Shellie Eldredge, a young mother who slipped into a coma after a moped accident in Hawaii broke nearly 50 of her bones, fractured her skull, snapped her spine and left her in a coma. Her doctors didn’t expect her to recover and even recommended stopping life support. Her husband, however, chose not to follow the recommendation. That turned out to be a great decision. After about a month in the hospital, Shelli recovered enough to go home.

The Case of Edwarda O’Bara

Shelli Eldredge was fortunate. Many people with severe brain injuries and in a coma never recover. Edwarda O’Bara is an example. She slipped into a diabetic-related coma when she was only 16 years old. Her parents cared for her in their home, feeding her through a tube until they died. After their deaths, her sister took over caring for her. She lived for 42 years in a coma and then died.

Using a Directive to Physicians to Communicate Your Wishes

The Directive to Physician allows you to state your preferences with regards to life-sustaining treatment. In it, you state whether you want your doctors to give, withhold or withdraw life-sustaining treatment if you are diagnosed with a terminal or irreversible condition and are unable to make your own health care decisions.

You get to decide, in advance, whether you want doctors to withhold all treatment other than that required to keep you comfortable, or alternatively, whether you want to be kept alive in your condition using available life-sustaining treatment.

Terminal and Irreversible Conditions

The Directive to Physicians allows you to state your preferences in two situations. The first situation addresses what you want to happen if are diagnosed with a terminal condition. The second situation addresses what you want to happen if you are diagnosed with an irreversible condition.

A terminal condition is defined as an incurable condition that will produce death within six months even if life sustaining treatment is given.

An irreversible condition is defined as a medical condition that:

  1. May be treated but is never cured or eliminated;
  2. Leaves a person unable to care for or make decisions for himself; and
  3. Is fatal without life-sustaining treatment.

The section dealing with irreversible conditions is the one that gives many people pause. Section 166.033 of the Tex. Health and Safety Code, the statute authorizing the form for a written directive, explains it in this way:

“Many serious illnesses such as cancer, failure of major organs (kidney, heart, liver, or lung), and serious brain disease such as Alzheimer’s dementia may be considered irreversible early on. There is no cure, but the patient may be kept alive for prolonged periods of time if the patient receives life-sustaining treatments. Late in the course of the same illness, the disease may be considered terminal when, even with treatment, the patient is expected to die. You may wish to consider which burdens of treatment you would be willing to accept in an effort to achieve a particular outcome. This is a very personal decision that you may wish to discuss with your physician, family, or other important persons in your life.”

The important thing to remember about the Directive is that it only becomes effective if you become incapacitated and are unable to make these decisions for yourself. And, you can revoke the Directive at any time, even if you are incapacitated, as long as you are able to communicate your wishes in some way.

Why Sign a Directive?

Signing a Directive is a difficult decision but it puts you in control of your end of life treatment by allowing you to specify in advance what life-sustaining treatment you will receive.

Consider the Edwarda Obara’s story previously mentioned. I wouldn’t want to live like that, would you? But, I wouldn’t want my family to end my treatment too soon either. I want my family to give me every possible chance to recover like Shelli Eldredge’s family did for her. But, if my condition is such that I will never be able to live a meaningful life, I know in advance that I don’t want to be kept alive artificially in a state of unconsciousness for decades. This is especially true in light of recent studies suggesting that some people living in vegetative states are actually conscious. Can you imagine being conscious but trapped in a body that can’t move or communicate for a lifetime?

Signing a Directive to Physicians relieves your family of the burden of making that choice on their own. Should your family disagree about how to proceed, having a directive from you can prevent family conflict.

Making your Decision

Deciding the time and circumstances for withdrawing or withholding life-sustaining treatment is a deeply personal one. It deserves serious thought and consideration. I recommend that my clients talk to people they trust before making such a decision. I specifically recommend they seek counsel from family members, physicians and clergy.

But, remember that the Directive is not written in stone. If you do change your mind about any aspect of it, you can revoke it completely or revoke it and sign a new one that is more in line with your new wishes.