Last Writes

Khloé Kardashian is a television personality whose life, along with that of her famous family, has played out before millions of viewers. On an episode of “The Kardashians,” she said her instructions require her nails to be done weekly if she is ever in a coma because people would be visiting her. A weekly manicure may not be part of everyone’s plan, but Kardashian’s unusual request makes an important point: your instructions can address more than whether you want a particular medical procedure. In Pennsylvania, an advance health care directive may be a living will, a health care power of attorney, or a document combining both. Although sometimes used interchangeably, they serve different purposes.

Living Wills

A living will communicates your wishes about life-sustaining treatment if you cannot communicate them yourself. It does not become operative simply because you are temporarily unconscious, hospitalized, or unable to speak. It becomes operative when a copy has been provided to your attending physician and the physician determines that you are incompetent and either have an end-stage medical condition or are permanently unconscious.

Pennsylvania law defines an end-stage medical condition as an incurable and irreversible condition in an advanced state that will result in death despite continued medical treatment. Permanently unconscious means a total and irreversible loss of consciousness and the ability to interact, including an irreversible coma or vegetative state.

Your living will can explain whether you want treatments that would only prolong the dying process or maintain you in a state of permanent unconsciousness. These decisions may include cardiopulmonary resuscitation, mechanical ventilation, surgery, dialysis, antibiotics, blood products, and artificially administered nutrition or hydration.

Pennsylvania law includes artificially administered nutrition and hydration within the definition of life-sustaining treatment when the advance health care directive specifically provides for it. In the absence of clear instructions, Pennsylvania law generally directs a health care agent to presume that the principal would not want artificial nutrition and hydration withheld or withdrawn, although that presumption may be overcome by other sufficiently clear evidence of the principal’s wishes.

A living will can spare your family from having to guess what you would want during an overwhelming time. It can also reduce guilt or conflict among relatives who may have very different beliefs about continuing treatment when recovery is no longer reasonably possible.

Health care Powers of Attorney

A health care power of attorney performs a broader role. It names an agent to make health care decisions when you are unable to make a particular decision yourself, including circumstances that do not involve an end-stage condition or permanent unconsciousness. The agent may communicate with providers, approve treatment, select care facilities, and make other decisions within the authority granted by the document.

Your manicure may be optional but making your wishes known shouldn’t be. The Bowles Rice Estate Planning, Trusts, Wills team can help you put those wishes in writing and ensure the right documents are in place for whatever the future holds.