How to Make Sure Your End-of-Life Wishes Are Followed
A living will is an important first step, but it may not guarantee your wishes are carried out. Learn how a POLST form and other simple measures can provide added protection.
Dear Savvy Senior,
I had a living will/advance directive prepared about 10 years ago documenting my end-of-life medical wishes, but I’ve read that these documents are often ignored. What can you tell me about this?
–Troubled Tina
Dear Tina,
Yes, unfortunately, it’s true. Living wills aren’t always followed in real life. Often, it’s simply because the document isn’t available when it’s needed or never makes it to the right people. They can also fall short because they’re not medical orders, and their language may be too vague to guide doctors in an emergency. That doesn’t mean your wishes won’t be respected. It just means a little extra planning can go a long way and save everyone stress later.
Here’s how you can make sure your wishes are honored.
Advance directive + POLST
About 40 percent of older Americans have an advance directive. This usually includes a living will that spells out the care you want if you become incapacitated, and a health care power of attorney (or proxy) naming someone to make decisions for you.
To give your instructions more weight, talk with your doctor about completing a POLST (Physician Orders for Life-Sustaining Treatment) – sometimes called MOLST (Medical Orders for Life-Sustaining Treatment) or POST (Physician Orders for Scope of Treatment), depending on your state. Unlike a living will, this is a doctor-signed medical order followed by EMTs and hospital staff that turns your wishes into clear instructions for treatments like CPR, breathing machines and feeding tubes.
These treatments can save your life but may also cause serious harm if you’re very sick or frail. Discussing these options now helps you think through the trade-offs and makes it easier for your family to understand your choices, which can reduce stress if a decision needs to be made quickly.
Even if you already have an advance directive, adding a POLST can make your wishes much clearer. Without one, first responders are usually required to attempt resuscitation and take you to a hospital, where doctors may pursue aggressive treatment if your living will isn’t on hand or specific enough.
Once your POLST form is completed, make sure it’s easy to find and use when it matters most. Keep one copy on the refrigerator, carry another in your wallet, and save a photo on your smartphone. Share copies with your health care proxy, family members, and doctors so everyone understands your wishes.
It’s also a good idea to ask your providers to add the form to your electronic health record, since medical information isn’t always shared between hospitals and care facilities. These simple steps can make a meaningful difference and help ensure your wishes are more likely to be honored.
If talking about these matters with your family feels awkward, websites like The Conversation Project and Prepare for Your Care can guide you.
One more tip: if you’re planning surgery, you may want to temporarily suspend your POLST during the procedure in case your heart stops briefly while in the operating room.
And if you haven’t created an advance directive yet, you can do so for free at caringinfo.org or mydirectives.com, or for a small fee – $5 to $7.50 – at fivewishes.org. Taking these steps now can help make sure your wishes are followed and ease the burden on your loved ones when the time comes.