Do you know how important it is to have a living will and advance directives?
Dr. Laurie Mortara, MD answers your questions about a Living Will such as:
Are living wills just for older adults?
Does one need a living will and a medical power of attorney?
Is it important to talk about your wishes with your family and/or friends?
How do you make a living will/advance directives?
These questions and more are answered here on your Weekly Dose of Wellness.
Selected Podcast
The Importance of Living Wills and Advance Directives
Featured Speaker:
Organization: MemorialCare Medical Group
Dr. Laurie Mortara, MD
Dr. Laurie Mortara grew up in Honolulu, Hawaii where she graduated from the University of Hawaii, John A. Burns School of Medicine. She came to Southern California and completed her residency at St. Mary Medical Center – UCLA where she was selected as Chief Resident. Dr. Mortara has been honored as a Top Doctor in her field.Organization: MemorialCare Medical Group
Transcription:
The Importance of Living Wills and Advance Directives
Deborah Howell (Host): Hello, and welcome to the show. You are listening to Weekly Dose of Wellness. It is brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Laurie Mortara. Laurie grew up in Honolulu and graduated from the University of Hawaii John A. Burns School of Medicine. She came to Southern California and completed her residency at Saint Mary Medical Center – UCLA, where she was selected as chief resident. Dr. Mortara has been honored as a top doctor in her field. Welcome, Dr. Mortara.
Dr. Laurie Mortara (Guest): Hello. How are you?
Deborah: Very good. Today we're going to be talking a little bit about how very important it is to have a living will. First off, what is a living will?
Dr. Mortara: Well, a living will is the oldest form of what we now know as an advanced directive. It was first proposed in 1969 by an attorney in Illinois, and it was to give basic directions to healthcare professionals regarding medical care. However, now, in California, we use something called the advance healthcare directive form and the difference is really that with technology and advances, this form gives four specific rights that can be done whole or in part to give instructions regarding: first, your own healthcare; second, to designate who your primary physician should be; third, to name someone to make decisions for you; and then fourth, to limit very specifically things that you may or may not want to have done to you in the end stages of life.
Deborah: Okay. Now, in whole or in part. Does that sometimes cause confusion if you just say in part?
Dr. Mortara: Well, actually, we encourage our patients to be very specific on these forms. Often, what people will write is a common phrase, "To do everything unless I'm not going to have a good life or a quality life, and then stop everything." But you have to think—and I ask my families—"What do you mean about a good life?" Your children may have very different ideas about this, and I encourage people to write a paragraph and to speak with their children before they sign their form. For instance is the ability to recognize people, to speak, to be able to walk, to do their hobbies, living independently, what are the things that you consider to be a quality of life? We placed those into the advance directive to help guide your agent or your family in making decisions.
Deborah: That's a great idea. Everybody should think about what their paragraph might say.
Dr. Mortara: Yes.
Deborah: Now, are living wills just for older adults?
Dr. Mortara: No. living wills, or now the advance healthcare directive, are actually for everyone. You may feel a little silly at 28 or 30 sitting with your doctor in good health and asking what would your thoughts be about end of life. But what I have found is that many people do have very strong opinions. Some people don't want to have blood, some people never want to be on a feeding tube, and some people want things done no matter what. Unfortunately, tragedies occur when you least expect them, and you may not have time to tell what your wishes are if they occur.
Deborah: It's the same as anything in life. As long as you put a little thought and planning into it, things will go better for you.
Dr. Mortara: Yes. I really think it's the best present that you can give not only to yourself but your family, because you want to be able to control what happens to you if a life-threatening event occurs, and you want to save your family and yourself suffering at the end of life, and allow your family to have the peace of mind that you did what you wanted, and have no guilt after they make the decisions that they make.
Deborah: And no divisiveness within the family, which is really hard.
Dr. Mortara: Often, we have that. Often, we have family members who have extremely different opinions and having this spelled out ahead of time is extremely helpful.
Deborah: Now, are there other advance directives besides the living will we should have, maybe medical POA and DNR or organ donation?
Dr. Mortara: Right. The advance healthcare directive form in California includes organ donation and includes your agent. There's something, however, that many people don't know, which is called the POLST. It stands for Physician Orders for Life Sustaining Treatment. This is something usually for people who have chronic illnesses or who have decided to have no resuscitation, the guide paramedics and first responders to follow. It's usually posted on the refrigerator, and the first responder would follow your orders. If you don't want to be on a breathing machine, you don't want CPR, they will follow this directive and then contact the physician. If you do not have this, the paramedics or first responders will start all life support. So for certain people, having the POLST in addition to the advance healthcare directive is very important.
Deborah: Once again, that's POLST. Now, does one need a living will and a medical power of attorney?
Dr. Mortara: Yes, you do need to have a medical power of attorney to state who would make decisions for you if you are incapacitated. If there is no decision-maker named, there is a legal definition—usually, the spouse, and then the children. But you may have someone else that you think is more able to make these decisions. Now, these forms can be printed off the Internet, they can be obtained from your doctor, they're available at the hospital, and even some office supplies stores sell common legal documents. You don't need to go to a lawyer, and you don't need to get them notarized, but they do need to be signed by two witnesses that are not beneficiaries in your will or in some other way going to benefit if they make a decision one way or the other.
Deborah: You made a good point. A lot of people are childless these days, so you need to think about the people in your life who you'd really trust with these things.
Dr. Mortara: And you need to talk to them beforehand and make sure that, first of all, they're willing to do this, but also that their opinions and their thoughts are meshed with yours.
Deborah: Now, there's another person you need to choose: a healthcare agent or a proxy. How do we go about that?
Dr. Mortara: The healthcare agent or the proxy is generally the agent, the durable medical power agent, and you can choose whoever you like, and you place it into this legal document and they then become your proxy.
Deborah: Interesting. Okay. Wow, this is a little bit complex. You have all the state laws, and then you have what your wishes are, and then you have these people that you need to trust, and you've got your proxy and your healthcare agent.
Dr. Mortara: It's actually quite simple. It's a 3-page form that you could fill out readily very quickly, and you don't need to involve all of these people. You simply write down what your wishes are, you show it to your proxy, they agree, and two witnesses sign it. You give one copy to each of your proxies, you keep some, you give one to your doctor. And let me actually say that your doctor is really important here. Even if you never fill out a form -- and right now, only about 40 percent of Americans have completed a living will in 2007.
Deborah: Really?
Dr. Mortara: Definitely, as part of your physical exam, your yearly physical with your doctor, discuss a bit about what your wishes are and who would make the decision, and make sure they have an active phone number and ask them to include it in their [progress note]. What will happen here is if you never get around to filling out the legal form, while what's written in the [progress note] is not legally binding, is that your physician can refer to it, say "Over the years, this is what your mother or your father was thinking," and I think that's very helpful.
Deborah: That is a fantastic idea. Once again, the suggestion was made by Dr. Mortara to speak with your family physician at your yearly physical and put your wishes in that medical record.
Dr. Mortara: That's true.
Deborah: That way, good intentions, you never, "Oh, I was going to fill up the form, but then it's too late."
Dr. Mortara: Exactly. I was very lucky and that my mother, who died in '83 from a stroke from diabetes, was one of the first people I knew who had a living will. Because she did and because her physician had a copy, he called us, we had a heartfelt discussion, and my family was able to just be freed from this decision and be able to be with each other over the week or so before she passed away. My father, without a written document, had so accurately told us what his criteria for quality of life was that, again, we were able to console each other and be with each other as opposed to focusing on should we put him on life support, take them off life support. It's always very sad when people spend the last parts of life arguing about life support and technology as opposed to loving and being supportive of each other.
Deborah: You're right. It's tragedy upon tragedy at that point.
Dr. Mortara: Yes, it is.
Deborah: How do you make a living will an advance care directive?
Dr. Mortara: Well, you just print off one of these forms or obtain it from your physician, and you fill in the three or four areas that discuss what your wishes are, and then you have it witnessed. Now, MemorialCare has done something interesting. January 25th, they've developed a conference called Half the Conversation, in which a palliative care physician, a psychiatrist, and a spiritual leader will meet with people and their families to help facilitate this discussion in a very positive way so that family members who may feel uncomfortable talking about end of life can have some help having this discussion. I'm hoping they're going to do this more frequently because I think it's a great idea.
Deborah: That's wonderful. Again, did you say January 25th?
Dr. Mortara: January 25 at Long Beach Memorial.
Deborah: Where's the location? Long Beach Memorial.
Dr. Mortara: At Long Beach Memorial Hospital. And you can go to the MemorialCare website, and there is some information there about this.
Deborah: That was my next question, where could people find out more.
Dr. Mortara: Yes.
Deborah: Again, the MemorialCare Health site.
Dr. Mortara: Right.
Deborah: I can't believe, we're out of time. This just flew. But we've learned so much, and we thank you so much, Dr. Mortara, for your time this morning.
Dr. Mortara: No problem. Happy to be here.
Deborah: It's been really informative to have Dr. Mortara on the program today to talk to us about living wills, advance directives and about how important it is to make your wishes now.To listen to the podcast or for more info, please visit memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness, brought to you MemorialCare Health System. Have a fantastic day.
The Importance of Living Wills and Advance Directives
Deborah Howell (Host): Hello, and welcome to the show. You are listening to Weekly Dose of Wellness. It is brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Laurie Mortara. Laurie grew up in Honolulu and graduated from the University of Hawaii John A. Burns School of Medicine. She came to Southern California and completed her residency at Saint Mary Medical Center – UCLA, where she was selected as chief resident. Dr. Mortara has been honored as a top doctor in her field. Welcome, Dr. Mortara.
Dr. Laurie Mortara (Guest): Hello. How are you?
Deborah: Very good. Today we're going to be talking a little bit about how very important it is to have a living will. First off, what is a living will?
Dr. Mortara: Well, a living will is the oldest form of what we now know as an advanced directive. It was first proposed in 1969 by an attorney in Illinois, and it was to give basic directions to healthcare professionals regarding medical care. However, now, in California, we use something called the advance healthcare directive form and the difference is really that with technology and advances, this form gives four specific rights that can be done whole or in part to give instructions regarding: first, your own healthcare; second, to designate who your primary physician should be; third, to name someone to make decisions for you; and then fourth, to limit very specifically things that you may or may not want to have done to you in the end stages of life.
Deborah: Okay. Now, in whole or in part. Does that sometimes cause confusion if you just say in part?
Dr. Mortara: Well, actually, we encourage our patients to be very specific on these forms. Often, what people will write is a common phrase, "To do everything unless I'm not going to have a good life or a quality life, and then stop everything." But you have to think—and I ask my families—"What do you mean about a good life?" Your children may have very different ideas about this, and I encourage people to write a paragraph and to speak with their children before they sign their form. For instance is the ability to recognize people, to speak, to be able to walk, to do their hobbies, living independently, what are the things that you consider to be a quality of life? We placed those into the advance directive to help guide your agent or your family in making decisions.
Deborah: That's a great idea. Everybody should think about what their paragraph might say.
Dr. Mortara: Yes.
Deborah: Now, are living wills just for older adults?
Dr. Mortara: No. living wills, or now the advance healthcare directive, are actually for everyone. You may feel a little silly at 28 or 30 sitting with your doctor in good health and asking what would your thoughts be about end of life. But what I have found is that many people do have very strong opinions. Some people don't want to have blood, some people never want to be on a feeding tube, and some people want things done no matter what. Unfortunately, tragedies occur when you least expect them, and you may not have time to tell what your wishes are if they occur.
Deborah: It's the same as anything in life. As long as you put a little thought and planning into it, things will go better for you.
Dr. Mortara: Yes. I really think it's the best present that you can give not only to yourself but your family, because you want to be able to control what happens to you if a life-threatening event occurs, and you want to save your family and yourself suffering at the end of life, and allow your family to have the peace of mind that you did what you wanted, and have no guilt after they make the decisions that they make.
Deborah: And no divisiveness within the family, which is really hard.
Dr. Mortara: Often, we have that. Often, we have family members who have extremely different opinions and having this spelled out ahead of time is extremely helpful.
Deborah: Now, are there other advance directives besides the living will we should have, maybe medical POA and DNR or organ donation?
Dr. Mortara: Right. The advance healthcare directive form in California includes organ donation and includes your agent. There's something, however, that many people don't know, which is called the POLST. It stands for Physician Orders for Life Sustaining Treatment. This is something usually for people who have chronic illnesses or who have decided to have no resuscitation, the guide paramedics and first responders to follow. It's usually posted on the refrigerator, and the first responder would follow your orders. If you don't want to be on a breathing machine, you don't want CPR, they will follow this directive and then contact the physician. If you do not have this, the paramedics or first responders will start all life support. So for certain people, having the POLST in addition to the advance healthcare directive is very important.
Deborah: Once again, that's POLST. Now, does one need a living will and a medical power of attorney?
Dr. Mortara: Yes, you do need to have a medical power of attorney to state who would make decisions for you if you are incapacitated. If there is no decision-maker named, there is a legal definition—usually, the spouse, and then the children. But you may have someone else that you think is more able to make these decisions. Now, these forms can be printed off the Internet, they can be obtained from your doctor, they're available at the hospital, and even some office supplies stores sell common legal documents. You don't need to go to a lawyer, and you don't need to get them notarized, but they do need to be signed by two witnesses that are not beneficiaries in your will or in some other way going to benefit if they make a decision one way or the other.
Deborah: You made a good point. A lot of people are childless these days, so you need to think about the people in your life who you'd really trust with these things.
Dr. Mortara: And you need to talk to them beforehand and make sure that, first of all, they're willing to do this, but also that their opinions and their thoughts are meshed with yours.
Deborah: Now, there's another person you need to choose: a healthcare agent or a proxy. How do we go about that?
Dr. Mortara: The healthcare agent or the proxy is generally the agent, the durable medical power agent, and you can choose whoever you like, and you place it into this legal document and they then become your proxy.
Deborah: Interesting. Okay. Wow, this is a little bit complex. You have all the state laws, and then you have what your wishes are, and then you have these people that you need to trust, and you've got your proxy and your healthcare agent.
Dr. Mortara: It's actually quite simple. It's a 3-page form that you could fill out readily very quickly, and you don't need to involve all of these people. You simply write down what your wishes are, you show it to your proxy, they agree, and two witnesses sign it. You give one copy to each of your proxies, you keep some, you give one to your doctor. And let me actually say that your doctor is really important here. Even if you never fill out a form -- and right now, only about 40 percent of Americans have completed a living will in 2007.
Deborah: Really?
Dr. Mortara: Definitely, as part of your physical exam, your yearly physical with your doctor, discuss a bit about what your wishes are and who would make the decision, and make sure they have an active phone number and ask them to include it in their [progress note]. What will happen here is if you never get around to filling out the legal form, while what's written in the [progress note] is not legally binding, is that your physician can refer to it, say "Over the years, this is what your mother or your father was thinking," and I think that's very helpful.
Deborah: That is a fantastic idea. Once again, the suggestion was made by Dr. Mortara to speak with your family physician at your yearly physical and put your wishes in that medical record.
Dr. Mortara: That's true.
Deborah: That way, good intentions, you never, "Oh, I was going to fill up the form, but then it's too late."
Dr. Mortara: Exactly. I was very lucky and that my mother, who died in '83 from a stroke from diabetes, was one of the first people I knew who had a living will. Because she did and because her physician had a copy, he called us, we had a heartfelt discussion, and my family was able to just be freed from this decision and be able to be with each other over the week or so before she passed away. My father, without a written document, had so accurately told us what his criteria for quality of life was that, again, we were able to console each other and be with each other as opposed to focusing on should we put him on life support, take them off life support. It's always very sad when people spend the last parts of life arguing about life support and technology as opposed to loving and being supportive of each other.
Deborah: You're right. It's tragedy upon tragedy at that point.
Dr. Mortara: Yes, it is.
Deborah: How do you make a living will an advance care directive?
Dr. Mortara: Well, you just print off one of these forms or obtain it from your physician, and you fill in the three or four areas that discuss what your wishes are, and then you have it witnessed. Now, MemorialCare has done something interesting. January 25th, they've developed a conference called Half the Conversation, in which a palliative care physician, a psychiatrist, and a spiritual leader will meet with people and their families to help facilitate this discussion in a very positive way so that family members who may feel uncomfortable talking about end of life can have some help having this discussion. I'm hoping they're going to do this more frequently because I think it's a great idea.
Deborah: That's wonderful. Again, did you say January 25th?
Dr. Mortara: January 25 at Long Beach Memorial.
Deborah: Where's the location? Long Beach Memorial.
Dr. Mortara: At Long Beach Memorial Hospital. And you can go to the MemorialCare website, and there is some information there about this.
Deborah: That was my next question, where could people find out more.
Dr. Mortara: Yes.
Deborah: Again, the MemorialCare Health site.
Dr. Mortara: Right.
Deborah: I can't believe, we're out of time. This just flew. But we've learned so much, and we thank you so much, Dr. Mortara, for your time this morning.
Dr. Mortara: No problem. Happy to be here.
Deborah: It's been really informative to have Dr. Mortara on the program today to talk to us about living wills, advance directives and about how important it is to make your wishes now.To listen to the podcast or for more info, please visit memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness, brought to you MemorialCare Health System. Have a fantastic day.