Issues that surround terminal illness, incapacitation, and death are not easy to talk about.

But it is often a lot easier for the immediate family if their loved one had drawn up an advance healthcare directive before being confronted with a traumatic accident or a serious illness. Without it, a person’s preferences with regards to the extent of life support measures cannot be heard or carried out.

In determining your health care wishes, you should always take your values into account.

These considerations should include your thoughts about the importance of self-sufficiency and independence, and where to draw the line when the quality of life is compromised. Also, you need to decide if your advance directives would prohibit life-sustaining and/or life-saving measures.

Before drafting your own estate planning documents it can help to be acquainted with the different treatments that are within its scope. In this way, you will be able to specify which of these measures you wish to receive or refuse in the event of incapacitation.

1. Resuscitation

This procedure aims to restart a heart that has stopped beating. Decide on when and if you wish to be resuscitated via CPR (cardiopulmonary resuscitation) or by a medical device that dispenses an electrical shock to revive the heart. The stage of a disease or the extent of injury matters in this situation therefore, try to be as specific as possible. You may fill out medical forms called DNR (do-not-resuscitate) or MOLST (Medical Order for Life Sustaining Treatment) orders to signify your desire to refuse such life-saving measure. These forms are usually attached to the medical record to forewarn the health care team.

2. Mechanical Ventilation

This life-sustaining measure involves the use of a machine that takes over a person’s ventilation in the event that he or she is incapable of spontaneous breathing. Reflect about when, if and for how long you would like to be attached to a mechanical ventilator.

You should also take your prognosis and condition into account, and whether or not it would matter to you if the doctors have high hopes about your recovery.

3. Hydration and Nutritional Assistance

These life-prolonging measures provide the body with much needed fluids and nutrients intravenously or through a nasogastric tube (NGT). Come to a decision about when, if and for how long you would like to receive sustenance in this manner.

4. Dialysis

In case of renal failure, this medical procedure gets rid of toxic wastes from your blood and controls fluid levels in your body.

5. End-of-life Care

Examples of treatment that fall under this category include the administration of painkillers, antibiotics, and mechanical ventilation. You should also determine whether you would like to receive these palliative measures even when death is imminent.

In general, these medical interventions can provide help in temporary situations wherein recovery is possible. However, in end-of-life stages, such measures could only add further discomfort and prolong the dying process.

Most conditions fall somewhere between minor and terminal so it is important to reflect upon when, if, and for how long you would like to accept treatment. These circumstances are often difficult to deal with but with preplanned guidance, things will be a lot easier for all involved.

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Planning ahead is a gift to your loved ones!

Richard K. Abraham, Esquire

Mr. Abraham is an experienced attorney and founding member of the Law Office of Richard K. Abraham. The Sparks, MD office of the firm concentrates its practice in Estate Planning, Elder Law, Probate, Medical Assistance (Medicaid), Guardianship, Asset Preservation and Fiduciary Representation.

He is an active member in a number of professional organizations that focus on law, the senior community, and estate planning. He works with clients in Central Maryland, especially in Towson, Hunt Valley, Lutherville/Timonium, Parkville, White Marsh, Bel Air & Northern Baltimore City.

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