"What about planning my finances?"
If you have only modest wealth and income, you and your family need to know what care is covered by Medicaid. Your best source of information is likely to be an experienced social worker. If, however, you have some property and savings, you really need to do some planning. This usually requires the help of a lawyer, though it may not cost much if things are pretty uncomplicated. The lawyer will help you think through your goals, both the goals you have while you are still living and those for after you have died. The kinds of arrangements that you can make are quite varied and sometimes complicated, but they are also often effective in securing good care while you need it, financial security for your spouse, and a legacy for others. Doing good financial planning takes some time, so try not to put this off until death is very close.

"Why do I need someone to speak for me?"
Your doctors should always know who to turn to for decisions when you cannot decide for yourself. If you have no close family - or your family doesn't work together very well - it is important to figure out who should be your "voice," and to involve that person in treatment decisions all along throughout your illness.

You can write your decision into a "durable power of attorney" or "health care power of attorney." This gives another person authority to make decisions if you become unable to do so. These designations are considered "durable" because they remain in effect even if you become unable to make decisions for yourself. Most people appoint a close friend or family member. If you don't have anyone, a minister or lawyer may serve. Make sure the person you choose will support you in the way that you want, under-stands your treatment choices, and knows what you value.

Giving someone else this authority is often more important than writing down preferences. Naming an advocate makes it easier for your choices to be recognized and followed. Otherwise, you risk having decisions made contrary to your wishes or by people you would not have chosen. This predicament also burdens those who love you by forcing them to make decisions without any clear guidance. Remember that these documents are only in effect when persons actually lose decision- making ability, and not before. Many people fear that these documents will override spoken wishes if they still have decision-making abilities, but this is not the case.

Durable power of attorney forms do not give explicit guidance to the proxy about what decisions to make. Many states have developed forms that combine the intent of the durable power of attorney (to have an advocate) and the intent of the living will (to state your choices for treatment at the end of life). These combination forms will probably be more effective than either of the two used individually.

"My mother had a living will but the doctor ignored it. Is this common?"
Some people assume that advance directives have not been as effective as they could be because doctors often ignore them. This is not true; in fact, doctors usually follow clearly stated directives. Directives aren't "followed" when they are too vague to indicate exactly what should be done. Many standard forms use the phrase "no heroic means" to describe the treatment the patient does not want. Just what does this phrase mean? What might be "heroic means" to one person may be ordinary to another. The classification often depends on your illness. Such imprecise and vague language doesn't really give much direction unless other conversations have made the meaning clear. Advance planning helps doctors know what you want, instead of having to guess.

"Is it legal to refuse life-sustaining treatment?"
Every American has the right to choose not to have any particular medical treatment. How do courts define "medical treatment?" When people become unable to breathe on their own, or unable to eat solid foods or drink liquids, they are sometimes put on a respirator to assist breathing or are given nutrients through tubes. Courts have defined these as "medical treatments" and have ruled that patients and families may decline to use them. Some people may consider it invasive or unnatural to have tubes inserted or to be hooked up to machinery. Others believe that if something can be done to extend their lives, they want it to be done. These are personal decisions that we have the right to make for ourselves. Hastening Death

"What else should I plan for?"
Doctors and others on the health care team will focus on medical treatment decisions. You, however, should have a very different agenda much of the time. Often, you will find it rewarding to make plans about who you want to see, what you want to do now, what should hap-pen near the time of death, and what should happen after death. These plans are all too easy to put off if you spend too much time and energy on thinking about medical treatment. If you find you have a great deal of anxiety over a specific medical treatment issue (resuscitation, for example), stop and ask your doctor whether this is really likely to matter much. Often, the honest answer is that the treatment won't make much difference (and the struggle is really over a symbol). Remember, enjoying this day is always important. Making plans for the people you cherish may be much more rewarding and important than anguishing over medical treatment decisions.

"All of this is sort of depressing, isn't it?"
Most of us would agree that we don't enjoy making decisions about dying. Yet, doing so allows you to feel more confident that you will have some control over how you live, even when very sick. Your loved ones will also feel more secure because they know what you want. Think through your choices for treatment at the end of life, then give this gift to your family. Don't force others to guess about your wishes when they are facing an emergency.