The Importance of Living Wills and Advance Directives

Intro: MemorialCare Health System, excellence in healthcare presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

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 St. 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.

Laurie Mortara, MD: Hello, how are you?

Deborah Howell (Host): Very good. Today we're going to be talking a little bit about how very important it is to have a living will. So first off, what is a living will?

Laurie Mortara, MD: 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 Advanced 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 health care, 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 and the end stages of life.

Deborah Howell (Host): Okay. Now, in whole or in part, does that sometimes cause confusion if you just say in part?

Laurie Mortara, MD: 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. You know, 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? And we place those into the advanced directive to help guide your agent or your family in making decisions.

Deborah Howell (Host): That's a great idea. Everybody should think about what their paragraph might say.

Laurie Mortara, MD: Yes.

Deborah Howell (Host): Now, are living wills just for older adults?

Laurie Mortara, MD: No, living wills are now the advanced healthcare directive that 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. And unfortunately, tragedies occur when you least expect them, and you may not have time to tell what your wishes are if they were to occur.

Deborah Howell (Host): You know, it's the same as, you know, anything in life. As long as you put a little thought and planning into it, things will go better for you.

Laurie Mortara, MD: Yes, I really think it's the best thing, the best present that you can give not only 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 they did what you wanted and have no guilt whatsoever after they make the decisions that they make.

Deborah Howell (Host): And no divisiveness within the family, which is really heartily.

Laurie Mortara, MD: 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 Howell (Host): Now, are there other advanced directives besides the living will we should have, maybe medical POA and DNR or organ donation?

Laurie Mortara, MD: Right. The Advanced 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 a POLST, P-O-L-S-T, and 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, to guide paramedics and first responders to follow. And it's usually posted on the refrigerator. And first, 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 the first responders will start all life support. And so for certain people, having the POLST in addition to the advanced healthcare directive is very important.

Deborah Howell (Host): And once again, that's P-O-L-S-T. Now, does one need a living will and a medical power of attorney?

Laurie Mortara, MD: 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 supply 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 Howell (Host): 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.

Laurie Mortara, MD: And you need to talk to them beforehand and make sure that their opinion, that first of all, they're willing to do this, but also that their opinions and their thoughts are meshed with yours.

Deborah Howell (Host): Now, there's another person you need to choose, a health care agent or a proxy. How do we go about that?

Laurie Mortara, MD: The health care 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 Howell (Host): Interesting. Okay, so, wow, this is a little bit complex. I mean, 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 health care agent. Okay.

Laurie Mortara, MD: It's actually quite simple. It's a three-page form that you can 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, and 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% of Americans have completed a living will in 2007, 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 notes. 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 and say, you know, over the years, this is what your mother or your father was thinking. And I think that's very helpful.

Deborah Howell (Host): 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.

Laurie Mortara, MD: That's true.

Deborah Howell (Host): That way, you know, good intentions, you're like, oh, I was going to fill out the form, but then it's too late.

Laurie Mortara, MD: Exactly. You know, I was very lucky in that my mother, who died in 83 from stroke from diabetes was one of the first people I knew who had a living will. And 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 these decisions 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 someone on life support, take them off life support. And 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 Howell (Host): You're right. It's tragedy upon tragedy at that point.

Laurie Mortara, MD: Yes, it is.

Deborah Howell (Host): How do you make a living will an advanced care directive?

Laurie Mortara, MD: 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. On January 25th, they've developed a conference called Have 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. And I'm hoping they're going to do this more frequently because I think it's a great idea.

Deborah Howell (Host): That's wonderful. Again, did you say January 25th?

Laurie Mortara, MD: January 25th.

Deborah Howell (Host): And where's the location?

Laurie Mortara, MD: At Long Beach Memorial Hospital. And you can go to the MemorialCare website and there is some information there about this.

Deborah Howell (Host): That was my next question. Where can people find out more. And so again, the MemorialCare Health site. And we just, 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.

Laurie Mortara, MD: No problem. Happy to be here.

Deborah Howell (Host): It's been really informative to have Dr. Mortara on the program today to talk to us about living wills, advanced directives, and about how important it is to make your wishes known. To listen to the podcast or for more info, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a fantastic day.