Plan for your life, and your end-of-life care

Most of us are planning to age gracefully then pass away peacefully in our sleep. That would be ideal — but life can throw us curveballs.

We plan for many serious life events: buying home insurance to protect from fires and floods, auto insurance in case of a car accident, and life insurance to prepare for the inevitable.

Yet most of us do not prepare our loved ones for how we want to spend our lives if we get seriously ill or injured. A 2013 survey by The Conversation Project found that only 27 percent of people have actually discussed end-of-life care with their loved ones, even though an overwhelming 90 percent believe it’s important to have that conversation.

Advances in medical technology make end-of-life conversations particularly important. A comatose or mentally incapacitated patient can be given treatment to prolong life for months or years, but if you don’t make your wishes known to your family, they won’t know whether or not you want to live this way. That’s why advance care planning is essential for all adults.

Everyone from millennials to aging kupuna should share with loved ones their preferences for care if they become seriously ill. It’s better to be prepared than to address these issues when a medical crisis occurs.

Living will

Your advance health care directive, also known as a living will, is a legal document that addresses what kind of care you’d like to receive in the event that you become incapacitated and cannot speak for yourself.

An advance care directive helps your loved ones make decisions about your health care when you cannot, avoiding any disputes between family members about the extent or type of care you receive. It offers peace of mind to all parties knowing that your wishes are being followed.

An advance care directive includes two sections:

>> Health care power of attorney: The first section will have you designate someone to make decisions about your care once you can’t communicate for yourself. This person, known as an agent, proxy or attorney-in-fact, will typically have the right to accept or refuse medical care, choose doctors, and view medical records, unless you place limits on their authority.

Choose a trusted loved one, often a spouse, adult child, sibling or close friend, that you know will be able to act in your best interests. This person will carry out your specified wishes, even if they conflict with the wishes of other family members or medical providers.

Talk to your designated agent about your wishes and make sure he or she is comfortable with carrying them out. You may also want to discuss religious or spiritual instructions that may provide comfort at the end of your life.

>> Individual instructions: The second part contains a series of questions about care and treatment. You’ll make decisions about whether you want treatment that prolongs your life, such as CPR or a ventilator.

You’ll also be asked about whether you want to receive artificial nutrition or artificial hydration if you cannot eat or drink on your own. While it may prolong life, it may also just be prolonging suffering.

You can also indicate whether you’d like to receive comfort care, including medication for pain, even if it might hasten your death.

What to do next

Have your completed document witnessed or notarized and provide copies to your agent, health care providers, relatives and anyone else that may be involved in your care. Keep a copy at home in a secure but accessible location, not in a safe deposit box.

Finally, review your advance care directive on a regular basis. Some life events, such as the death of a loved one or birth of a grandchild, will make you think differently about your end-of-life wishes.

To get started, visit kokuamau.org to download a free Hawaii advance care directive form or talk to your health care provider.

Dr. Aleza Matayoshi is a physician at Kaiser Permanente Moanalua Medical Center.