When I describe an estate plan as “a love letter to the people who love you,” I’m not being sentimental. I’m speaking from decades of experience witnessing peaceful and painful deaths, both as a hospice chaplain at patients’ bedsides and as an attorney helping families navigate the legal realities when planning hasn’t been done.
I’ve learned that Advance Directives aren’t just legal documents. They’re acts of compassion that protect the people you love most at the end of your life.
Understanding the Medical System’s Default
Our healthcare system has a default setting to do everything possible to keep you alive. I call it “the freight train” of end-of-life medical care. This can include emergency room visits, hospital admissions, and elaborate interventions, one after another.
This isn’t a criticism of doctors or nurses. It’s simply how the system works. Our medical system is set up to be primarily interventionist, especially at the end of life. And without clear guidance from you, that freight train keeps moving, often long past the point where treatments contribute to any meaningful quality of life.
I’ve seen what unfolds when someone becomes incapacitated without the proper planning in place. The consequences are real and far-reaching:
- Your family agonizes. Without knowing your wishes, loved ones face impossible decisions. Disagreements happen, sometimes between spouses and adult children, sometimes among siblings. One child may feel we must do everything possible to keep you alive. Another may believe you’re suffering needlessly. These conflicts can divide families.
- You may receive unwanted care. Without your documented wishes, you might end up on a ventilator, receiving aggressive chemotherapy, undergoing procedures or treatments you never would have chosen for yourself.
- Your family faces financial and legal hurdles. If there’s no Medical Power of Attorney and no clear decision-maker, families often need to go to court for Guardianship. This costs thousands of dollars and creates significant delays. I’ve seen patients stuck in hospital limbo, unable to be discharged to appropriate care, simply because there’s no one with legal authority to make decisions.
- A judge may appoint someone you wouldn’t choose. Colorado law allows “interested persons” to step in, including friends, neighbors, and even strangers. A court-appointed guardian may not know your values or understand what matters to you.
These are not abstract risks. I work with families navigating these situations regularly.
Advance Directives and Medical Powers of Attorney: Understanding the Difference
Many people confuse these documents or think they’re the same thing. They’re not. You need both, and they serve different purposes:
- A Medical Power of Attorney names the person who will make healthcare decisions for you if you can’t speak or communicate your wishes. This is your agent, the person who stands in your shoes. The most important thing about a Medical Power of Attorney is choosing the right person and talking to them about your values and wishes.
- An Advance Directive (Living Will) is where you document your specific wishes about end-of-life care in certain medical situations. This gives your agent the roadmap they need to make decisions on your behalf. It relieves them of the burden of guessing what you would want.
Think of it this way: the Medical Power of Attorney says who decides. The Advance Directive says what you want decided. Together, these documents ensure the right person is empowered to make decisions and knows exactly what your wishes are.
What an Advance Directive Actually Covers
In my practice, I make sure your Advance Directive addresses three specific scenarios:
- Terminal condition. When two physicians certify you’re terminally ill, your directive states whether you want life-sustaining procedures (think ventilators and respirators) and for how long. It also covers artificial hydration and nutrition, which means tube feeding. These decisions give your agent a roadmap. They’ll stand in your shoes and advocate for what you’ve already decided.
- Persistent vegetative state. This provision exists because of Terri Schiavo, the young woman whose case ended up on the floor of Congress due to a disagreement between her husband and parents. Think of this as a long-term coma. No doctor I know would formally diagnose it (they don’t want to end up in Congress either), but you still need to address it. Your directive guides decisions about respirators and artificial nutrition when meaningful recovery is unlikely.
- COVID and its variants. I don’t know anyone else who includes this separately, but I do, and here’s why: I had a 92-year-old neighbor on a ventilator for 21 days with COVID. The next week, he was doing yard work. Unlike other terminal conditions, COVID can warrant extended ventilator use with real potential for full recovery. I always separate this, so beneficial treatments aren’t limited by restrictions meant for other situations.
You’ll notice dementia isn’t on this list. That’s intentional. I’ve developed a separate dementia planning form that covers mild, moderate, and severe stages, and what levels of care you want and what your goals are in each phase. It hasn’t been tested in court yet, so I keep it separate. I don’t want one untested provision to invalidate your entire Advance Directive. Almost every family I work with has been touched by dementia in some way, and this document provides crucial guidance.
Your Medical Power of Attorney and Advance Directive work together to protect your autonomy, honor your values, and spare the people you love from impossible decisions during a painful time. Together, they provide both the authority and the roadmap your loved ones need. Let’s make sure you have these documents in place. Talk to an estate planning attorney who understands both the legal requirements and the human realities of end-of-life care.
If you would like to watch the webinar that inspired this blog, you can watch the recording of “Your Wishes, Your Way: Getting the End-of-Life You Want”
