Summary: The Documents That Save Your Family

Two adult children in two different hospital waiting rooms on two different nights, and the difference between their experiences is four pieces of paper.

Thomas Vance, 52, reached the hospital forty minutes after his mother Elaine, 79, arrived unconscious after a fall. He had a folder in his car: a healthcare power of attorney naming Thomas as Elaine’s decision-maker, a living will specifying her wishes for life-sustaining treatment in plain clinical language, and a POLST form signed by Elaine’s physician six months ago. Thomas handed the folder to the charge nurse. Care proceeded according to what Elaine had chosen, documented, and signed while she was still able to choose.

Donna Briggs, 49, arrived at a different emergency room after her father Arthur, 81, had a massive stroke. She had nothing. Arthur was intubated and placed on a ventilator because the default in American emergency medicine, absent documentation to the contrary, is to sustain life by every available means. Donna and her brother Marcus disagreed about the ventilator. Donna believed their father would not want to be maintained on life support. Marcus believed they should give him every chance. The hospital ethics committee was consulted. The decision took four days. During those four days, Arthur was maintained on life support because there was no documentation of what he would have wanted, and the people who loved him most could not agree.

The article describes each of the four documents with clinical specificity. The healthcare power of attorney designates the decision-maker for medical decisions when you cannot make them yourself. It takes effect only when a physician determines that you lack the capacity to make those decisions. The living will specifies the medical treatments you do or do not want in specific clinical scenarios. The distinction between a useful living will and a useless one is specificity: a document that says “I do not want to be kept alive by machines” is a sentiment, not a medical directive, and an emergency room physician cannot act on a sentiment. An effective advance directive specifies the conditions under which it applies, the interventions being accepted or refused, and the goals-of-care philosophy that guides decisions for situations not explicitly listed.

The POLST form is a physician order, not a preference document. It is signed by both the patient and the physician. It travels with the patient. Emergency medical services personnel can act on a POLST immediately, without consulting anyone, without waiting for a family member to arrive. The EMS standard in most states: check the refrigerator door. That is where the form should be kept. Paramedics check there first.

The will and beneficiary designations receive a careful distinction most people miss: beneficiary designations on retirement accounts and life insurance policies supersede the will. If your will says everything goes to your daughter but your IRA still lists your ex-wife as beneficiary because you never updated it after the divorce, the IRA goes to your ex-wife. The will does not override the beneficiary designation. Updating beneficiary designations is free and takes a phone call. Most people who need to update them have not.

What can be done without a lawyer receives honest coverage. Advance directives, healthcare powers of attorney, and basic wills for uncomplicated situations can all be prepared without an attorney. State-specific forms are available free through most state bar associations and state health departments. Five Wishes is available for $5 and legally valid in 42 states, written in plain language rather than legal terminology. What requires an attorney is also named: trusts of any kind, estates with business interests, blended family situations, anticipated family conflict over the estate, and cross-state situations.

These documents need review after major life changes: a significant new diagnosis, the death or incapacity of a named decision-maker, a move to a different state, a material change in assets, or a change in wishes. An agent that tracks life events and prompts review when an update is warranted ensures that the documents remain current.

Arthur’s children are guessing in a waiting room. Elaine’s son is grieving in a different waiting room, but not guessing. The difference is four pieces of paper that could have been prepared on any Saturday in the last ten years. This Saturday is available.

Read the full article on BlueMirror.life.