By Jennifer FitzPatrick

Special to Chesapeake 360

Have you created an advance directive or living will? Do your loved ones know where to find it? People tend to think about advance directives only when someone is ill or there is an elderly family member. But everyone older than 18 years old should have an advance directive.

Advance directives are documents that explain how medical decisions should be made when a person is no longer able to express his or her wishes. According to the American Bar Association, more than half of Americans have no advance directives.

Advance directives can take the form of living wills. Living wills can be completed with legal assistance but also can be done independently. Living wills allow a person to answer questions about under which circumstances he would want or not want a feeding tube, respirator, CPR or other type of life-saving intervention when faced with a terminal condition. Advance directives also allow a person to identify an individual who may make his or her healthcare decisions if he or she is unable to.

One of the reasons living wills are not created as healthcare providers recommend is because some people find the language and imagery the document’s questions conjure up daunting. Nobody wants to think about their last days dying from cancer or being in a tragic accident. Also, some people can be a bit superstitious about it, thinking if they prepare this document they will die tomorrow.

So why put yourself through thinking about this sad and scary task?

1. When you have an advance directive, you are in control. Your words and wishes are in writing.

2. You are making it simple for your doctor and healthcare providers to ethically and legally give you the treatment (or lack of treatment) you desire.

3. Your loved ones don’t have to guess. Often older adults frequently assume that their spouses, adult children, or other loved ones “will just know” what they want. Hospitals, nursing homes and other healthcare venues have lobbies and waiting rooms filled with loved ones who don’t know what their older loved one wants. Often they are making their best guess.

4. Everybody’s definition of “what’s best” is different.

Perhaps your wife, your sister and your daughter are trying to decide if you should remain on a ventilator. They all might love you very much and want “what’s best” for you. But they all have different ideas of what that means. Legally your wife is your next of kin (even when you have not prepared an advance directive) and she has decision-making power. Rather than doing simply what she thinks is best, wouldn’t it be great if she could show your sister and daughter your wishes in writing? Without that, if she simply does what she thinks is best, your sister and daughter might wind up very angry with her if they don’t agree, which leads us to another reason advance directives are so important.

5. You are likely saving your family from heated arguments and even estrangements.

Perhaps you’ve had a conversation with one of your adult children about your end of life wishes. This adult child tells her siblings that you would not want a feeding tube. Because everyone is under a lot of stress, worrying about you, her siblings question this:

“When did you discuss this with Mom? What did she say? I never heard her say that. Do you want our mother to starve to death? The doctors are saying we should do it.”

Disagreements about serious healthcare decisions can have lasting consequences even in the most harmonious families. Obviously when there is already friction in a family, these disagreements can be even more devastating and lead to estrangements.

For information on preparing an advance directive, visit the Maryland Office of Attorney General at or call 888-743-0023.

If you would like assistance from an elder law attorney in preparing an advance directive, here are some helpful databases:

• National Elder Law Foundation:

• Life Care Planning Law Firms Association:

• The National Academy of Elder Law Attorneys:

Jennifer FitzPatrick is the founder of Jenerations Health Education, a gerontology instructor at Johns Hopkins University and an education consultant for the Alzheimer’s Association. For more information, visit

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