What is an advance directive? Why is it so important? Why do people put off creating them? We posed these questions to Jessica Greene, a Certified Elder Law Attorney at Walters & Galloway, PLLC, a Life Care Planning Law Firm in Mechanicsburg, Pennsylvania. Jessica has more than a decade of experience helping families address these delicate issues.
Though Jessica deals with advance directives every day in her elder law practice, she admits that it’s rarely a fun topic. “People don't want to think about end-of-life planning,” she said. “No one looks forward to thinking about being incapacitated or what their wishes for treatment might be.”
Advance directives as we know them today have only been around since the mid-1960s. They came into being as a result of concern over patients undergoing unwanted medical treatment in order to preserve life at any cost. Tube feeding, CPR, and ventilator use are just a few of the many topics covered. Advance directives are a vital tool for people who want to make sure their wishes are known.
Jessica notes that only about one-third of Americans have advance directives. “It’s fascinating to consider how many people haven’t created an advance directive,” she said. “Two thirds of Americans won't have their wishes followed if something does happen to them.”
Advance directives vary by state. In Pennsylvania, where Jessica practices, the state-generated form combines the healthcare power of attorney and living will into a single document. Anyone can get the document from their healthcare provider, yet Jessica warns that this ease of access can create a false sense of security. “People will say,’ My doctor gave me this form, so I don't need you to review it,’” she cautions. “I still ask them questions about it to make sure that they understand what it says and that it expresses what they truly want.”
Jessica says that it is common for state-issued forms to make generic statements about treatments, which may or may not accurately express a person’s true wishes. “Generic forms often leave things out,” Jessica explained. “The advance directive form I use includes blank spaces where my clients can write in guidance for their agents, making their wishes absolutely clear.”
Having an advance directive is even more important now, with ventilators being used to treat advanced cases of COVID. “Not everyone wants that,” Jessica said. “Your best bet is to work with an elder law attorney in a Life Care Planning Law Firm. They work every day on these complicated legal issues related to medical care.”
What’s in store for the two-thirds of Americans who lack advance directives? Jessica warns that they risk learning the hard way what can happen if you don’t have this important document. “Doctors take an oath to save lives, so if you don't offer clear direction that you want to withdraw support or you don't want life-prolonging procedures, you will get them,” she added. If you don’t have an advance directive, your family will end up in court fighting over it. It's so much easier for everyone if you create an advance directive now so everyone knows what your wishes are. If you’re not willing to do it for yourself, do it for your family. They’ll thank you for it.”