Savvy
Senior How to Make Sure Your End-of-Life Wishes Are Followed
Dear Savvy Senior,
I had a living will/advance directive prepared about 10 years ago documenting my end-of-life medical wishes, but I’ve read that these documents are often ignored. What can you tell me about this?
--Troubled Tina--Struggling Patient
Dear Tina,
Yes, unfortunately, that can happen. Living wills aren’t always followed in practice, most often because the document isn’t available when it’s needed or never reaches the right people in time. They can also fall short because they aren’t medical orders, and the language may be too vague to guide doctors in an emergency. That doesn’t mean your wishes won’t be honored, but it does mean a little extra planning can help prevent confusion later.
Here’s how to make sure your wishes are followed.
Advance directive + POLST - About 40 percent of older Americans have an advance directive. This typically includes a living will that spells out the care you want if you become incapacitated, and a health care power of attorney (or proxy) who is authorized to make decisions on your behalf.
To strengthen those instructions, talk with your doctor about completing a POLST (Physician Orders for Life-Sustaining Treatment) – sometimes called MOLST or POST depending on your state. Unlike a living will, this is a doctor- signed medical order that must be followed by EMTs and hospital staff. It translates your wishes into clear instructions for treatments such as CPR, breathing machines, and feeding tubes.
These interventions can save lives but may also cause harm if you are very ill or frail. Discussing them ahead of time helps you weigh the trade-offs and makes it easier for your family to understand your choices, easing stress if decisions must be made quickly.
Even if you already have an advance directive, adding a POLST can make your wishes clearer. Without one, first responders are generally required to attempt resuscitation and transport you to a hospital, where doctors may pursue aggressive treatment if your living will isn’t available or specific enough.
Once your POLST is completed, make sure it is easy to find. Keep a copy on the refrigerator, carry one in your wallet, and save a photo on your phone. Share copies with your health care proxy, family members, and physicians so everyone is aligned.
It’s also wise to ask your providers to add the form to your electronic health record, since medical information isn’t always shared between hospitals and care facilities. These steps can make a real difference in helping ensure your wishes are followed.
If discussing these issues with family feels difficult, websites like The Conversation Project (theconversationproject. org) and Prepare for Your Care (prepareforyourcare.org) offer helpful guidance.
One final note: if you’re planning surgery, you may want to temporarily suspend your POLST in case your heart stops briefly during the procedure.
And if you haven’t yet created an advance directive, you can do so for free at caringinfo.org or mydirectives. com, or for a small fee – $5 to $7.50 – at fivewishes. org. Taking these steps now can help ensure your wishes are followed and ease the burden on your loved ones later.
Send your questions or comments to [email protected], or to Savvy Senior, P.O. Box 5443, Norman, OK 73070.
