Estate planning isn't only about distributing your wealth after death—it's also about ensuring your wishes are followed if you become unable to make decisions during your lifetime. Healthcare directives and living wills are essential documents that communicate your medical care preferences and designate someone to make healthcare decisions on your behalf if you cannot. For high-net-worth individuals, these documents protect both your personal autonomy and your family from difficult decisions during already stressful times.
Estate planning isn't only about distributing your wealth after death—it's also about ensuring your wishes are followed if you become unable to make decisions during your lifetime. Healthcare directives and living wills are essential documents that communicate your medical care preferences and designate someone to make healthcare decisions on your behalf if you cannot. For high-net-worth individuals, these documents protect both your personal autonomy and your family from difficult decisions during already stressful times.
What Are Healthcare Directives?
Healthcare directives are legal documents that express your wishes regarding medical treatment if you become incapacitated and unable to communicate. They ensure your preferences are followed and relieve family members from the burden of guessing what you would want.
The umbrella term "healthcare directive" often encompasses several specific documents. A living will specifies what medical treatments you do or don't want in specific end-of-life scenarios. A durable power of attorney for healthcare designates someone to make medical decisions on your behalf. A do-not-resuscitate order instructs medical personnel not to perform CPR if your heart stops or you stop breathing.
Some states use combined advance directive forms that include both living will provisions and healthcare power of attorney designations in a single document. Others use separate forms for each purpose. The terminology varies by state, but the underlying goals remain consistent.
The Living Will: Expressing Your Treatment Preferences
A living will allows you to document your preferences for life-sustaining medical treatment in situations where you have a terminal condition, are permanently unconscious, or are in an end-stage medical condition with no reasonable hope of recovery.
You can specify whether you want artificial nutrition and hydration, mechanical ventilation, cardiopulmonary resuscitation, dialysis, antibiotics, or other interventions if you're in these situations. Some people want all possible measures taken to prolong life. Others prefer comfort care only, focusing on pain management and dignity rather than life extension when recovery is unlikely.
The value of a living will is relieving your family from making these emotionally wrenching decisions without guidance. Rather than family members disagreeing about what you would want, your documented wishes provide clear direction.
However, living wills have limitations. They typically only apply to end-of-life situations, not to other medical decisions you might face. The scenarios described in standard forms may not cover every possible situation. Language can be vague—what constitutes "reasonable hope of recovery" or "terminal condition" may be subject to interpretation.
Healthcare Power of Attorney: Choosing Your Healthcare Agent
A durable power of attorney for healthcare designates someone to make medical decisions on your behalf if you're unable to communicate or make decisions yourself. This person, called your healthcare agent, proxy, or attorney-in-fact, acts according to your known wishes or, if your wishes are unknown, in your best interest.
Choosing your healthcare agent is one of the most important estate planning decisions you'll make. This person needs to be someone you trust completely who will honor your values and preferences. They should be willing and able to serve, emotionally capable of making difficult decisions under stress, and likely to be available when needed.
Many people name their spouse as primary healthcare agent, with adult children or other family members as successors. However, the right choice depends on family dynamics, geographic proximity, and individual capabilities. Sometimes the best choice is a family member who isn't the obvious one—perhaps a sibling or adult child who's particularly level-headed during crises.
Your healthcare agent has broad authority to make medical decisions, including consenting to or refusing treatment, choosing healthcare providers and facilities, accessing your medical records, and making end-of-life decisions consistent with your values if you haven't specified preferences in a living will.
What Healthcare Agents Can and Cannot Do
Understanding the scope and limitations of healthcare agent authority helps you structure effective healthcare directives. Your agent generally can make decisions about medical treatment, surgery, diagnostic procedures, and medication. They can consent to mental health treatment, choose whether to donate organs for transplant, and determine disposition of your body after death.
However, healthcare agents typically cannot make decisions contrary to clearly expressed wishes in your living will, consent to illegal actions, override you if you're able to make decisions yourself, or make financial decisions unless also named in a financial power of attorney.
Some states impose additional restrictions, particularly around mental health treatment, sterilization, or psychosurgery. Understanding your state's specific rules ensures your documents provide appropriate authority.
The HIPAA Authorization Component
Healthcare directives should include HIPAA authorization language allowing your healthcare agent and other designated individuals to access your medical information. Without this authorization, healthcare providers may be prohibited from discussing your condition with family members, even when they're trying to make decisions on your behalf.
HIPAA authorizations can be as broad or narrow as you choose. Some people authorize their healthcare agent only. Others include additional family members they want to be informed about their condition. For high-net-worth individuals, including your financial advisor might be appropriate if your capacity affects financial decisions they're helping implement.
Do-Not-Resuscitate Orders and Physician Orders for Life-Sustaining Treatment
Beyond advance directives, additional documents can clarify your preferences for specific interventions. A do-not-resuscitate order tells emergency medical personnel and healthcare providers not to perform CPR if your heart stops.
DNR orders are most relevant for individuals with serious chronic illnesses where CPR is unlikely to restore quality of life. They're typically signed by a physician and accompany you to ensure emergency responders honor your wishes. Without a DNR order, emergency personnel will typically attempt resuscitation.
Physician Orders for Life-Sustaining Treatment forms provide more detailed guidance about interventions like ventilators, feeding tubes, and other life-sustaining measures. Unlike living wills, which are general instructions, POLST forms are actual medical orders signed by physicians.
Mental Health Considerations
Healthcare directives can include instructions regarding mental health treatment. For individuals with history of mental health conditions or strong preferences about psychiatric treatment, documenting wishes about hospitalization, medication, and specific treatments provides important guidance.
Some states allow psychiatric advance directives that specifically address mental health care preferences. These can specify preferred medications, treatments to avoid, and preferences about hospitalization or ECT.
Coordinating Healthcare Directives Across State Lines
If you spend significant time in multiple states, ensure your healthcare directives comply with laws in each state. While states generally honor healthcare directives from other states, variations in requirements or terminology can create uncertainties.
Some people execute healthcare directives in each state where they spend time, ensuring compliance with local requirements. Others execute comprehensive directives that meet the most stringent requirements across relevant states.
Communicating Your Wishes to Family and Providers
Having healthcare directives is only valuable if people know they exist and can access them when needed. Give copies to your healthcare agent and successor agents so they have them available. Provide copies to your primary care physician and specialists who might be involved in your care if you become seriously ill.
Discuss your wishes with your healthcare agent and close family members so they understand your values and preferences. This conversation is often more valuable than the documents themselves, as it helps your agent make decisions consistent with your wishes in scenarios the documents may not specifically address.
Keep the original documents somewhere accessible—a home safe or with your attorney—but ensure your family knows where they're located. Some people keep wallet cards noting they have healthcare directives and where to find them.
Updating Healthcare Directives
Healthcare directives should be reviewed periodically, particularly after major life changes like marriage, divorce, births, deaths of named agents, or diagnosis of serious illness. Your preferences may evolve, particularly as you age or experience health challenges.
Some estate planning attorneys recommend reviewing healthcare directives every three to five years. Others suggest reviewing whenever you update your will or other estate planning documents.
If you create new healthcare directives, formally revoke old ones and destroy old copies to avoid confusion. Inform people who had copies of old directives that you've created new versions.
Working With Professionals
While basic healthcare directive forms are available online, working with an estate planning attorney ensures documents are properly executed, comply with state law, coordinate with your other estate planning documents, and address any special circumstances in your situation.
For high-net-worth individuals with complex family situations or strong preferences about medical care, professional guidance is particularly valuable. Attorneys experienced in this area can structure documents that provide clarity while maintaining appropriate flexibility.
This material is for general information only and is not intended to provide specific advice or recommendations for any individual. Healthcare directive requirements vary by state. Consult with an estate planning attorney regarding documents appropriate for your circumstances.
Securities offered through LPL Financial, Member FINRA/SIPC. Investment advice offered through Great Valley Advisor Group, a registered investment advisor and separate entity from LPL Financial.
Chesapeake Financial Planners | 2402 Scotlon Ct, Forest Hill, MD 21050 | (410) 652-7868 | www.chesapeakefp.com
