End-of-life Planning: Not Only for the Elderly
For many people, COVID-19 turned some key assumptions about healthcare upside down. For example, some individuals may have faced the need for extraordinary medical care, such as going on a ventilator, well before the age they may have anticipated. The pandemic also highlighted how many people—especially the young—don’t 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’re 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 close friend or family member) to make medical decisions on their behalf. As well, this document typically includes directions about the type of care you want if you’re 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 may 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 isn’t just for your own benefit. It can also provide clarity to your loved ones and prevent disagreements or confusion at a time when they’re being forced to make a difficult “life or death” decision.
How do I create and use a living will?
Since a living will is a legal document, consider having an estate attorney prepare it for you. However, your state may have standard forms or other options available, free of cost, if you wish to go the DIY route.
A living will applies in a hospital or care facility.3 Plan to share your document with your doctor and healthcare agents. It’s also helpful to discuss your wishes in advance with your loved ones, so they’re 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 showed 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 you plan for unexpected events by writing it now. In our view, you should also be ready to update your living will if circumstances 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 order applies both inside and outside a medical facility.5
Who is this document appropriate for?
A DNR order is typically appropriate for someone who is likely near the end of their life or who has a serious 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, given that a DNR order is such a major decision.
How do I create a DNR order?
If you determine that you don’t 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 there when responding to house calls.7 It’s 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 maintain 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 or destroy any documents you had 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 (such as your Corient Wealth Advisor) to review your documents and ensure they are comprehensive and accurately reflect your wishes.
Finally, since your feelings may change over time, your specific directions about what type of care you’d like to receive at the end of life may also change. Regularly review your related documents and communicate any changes to your doctor and caregivers. This type of planning will help you live out your life according to your wishes, while also providing 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.
