As the world reacted in shock to the news that comedian Joan Rivers had suffered respiratory failure and was in a coma, her daughter Melissa Rivers faced a difficult decision. After Joan spent nearly a week on life support, it was medically determined that nothing could be done for the beloved star. Melissa Rivers then made the painful choice to remove life support so her mother could pass.
Advance Directives Prepare Everyone in Advance
Some media outlets report that Joan Rivers had an advance directive that indicated she did not want to be kept alive on life support. This document, sometimes called a living will, allows you to spell out exactly what kind of medical care you do and do not wish to receive at any point when you are unable to make medical decisions for yourself (such as being in a coma). An advance health care directive can be as detailed as you wish and discuss care such as feeding tubes and hydration, surgery, experimental treatments, life support, pain medication, resuscitation, and dialysis. It can also specify if you wish to be an organ donor after your death. This document is binding and your physicians must follow your wishes. Note however that if EMTs are called, they are not required to honor it and must provide lifesaving treatment.
Decisions Without Documents
If you do not have an advance directive, your medical team will not know your wishes and will be unable to tailor your treatment if you are in a situation where you are incapable of making your own decisions. Physicians will turn to your next of kin (generally spouse and children) and ask them to make the decisions for you. This can be wrenching and difficult for family to do when they don’t know your specific wishes and are faced with crucial end of life situations. Creating an advance directive lifts this burden from your family and creates a medical plan based on what you’ve specified. There will be no uncertainty for anyone.
Talk About the Future
Before you complete an advance medical directive, it’s important to take some time to think about exactly what you want and what the implications of certain treatments are. It can be helpful to talk to your physician before making a final decision. Once you know what you want, it is a good idea to talk to your spouse and/or children so that everyone understands your thoughts. It might be helpful to mention the Joan Rivers case to start the conversation or to use it as an example.
Prepare Your Documents
An advance directive is completely separate from other documents you may have prepared, such as a will or power of attorney, and must be prepared according to your state’s requirements, since each state has different forms and laws.
Another important component of planning for your future care is to execute a health care power of attorney, or health care proxy. This document allows you to name a person or persons who have the authority to make medical decisions on your behalf should you not be able to (this includes life-threatening conditions like comas as well as when you are under anesthesia). Joan Rivers most likely named her daughter Melissa. Most people choose a spouse or adult child. This is an important decision since you want to choose someone who can handle the responsibility and who will honor your wishes. You can also name an alternate so that if your first choice is unavailable, there is still someone able to make decisions for you. In some states, an advance directive and health care power of attorney can be executed in one document; in others they are separate.
Once you complete an advance directive, health care power of attorney, or living will, distribute copies to your family and primary physician. Taking the time to consider your future now can relieve your family of painful decisions later.