When I was newly married, my mother-in-law, Margaret, took me aside one day during a visit, and casually showed me the file in which she and her husband kept their end-of-life wishes.

She patted the wooden file cabinet, pulled open the drawer to show me the file’s location right in front, and then closed it, and we went on visiting.

At the time, I thought it was sweet to be included. Later, I realized what a great gift they’d given their family.

Dealing with the decline of loved ones is an agonizing ordeal, and it’s made worse by having to figure out wishes using hindsight.

I appreciated Margaret, always kind and gracious, even more when the time came to carry out those wishes. She was stricken with Parkinson’s, and even though there were many choices to be made, the way was clear, thanks to her foresight. Although she wasn’t able to acknowledge any gratitude at the end, it’s endured far beyond her death.

ADVANCE DIRECTIVES

Washington state recognizes advance directives, the written and oral instructions about future medical care made by a person for a time when he or she is unable to speak for himself or herself.

Washington state law specifies, in hierarchical order, who may speak for you when you can’t. First is a guardian with health care decision-making authority, if one has been appointed, then the person named in your durable power of attorney with health care decision-making authority. Next are your spouse, your adult children, your parents, and your adult brothers and sisters. If you are in one of the last three categories and there is more than one person in that category, they must all agree. If your family has differences of opinion, it’s a good idea to make sure your wishes are reflected in specific documents.

THREE TYPES

There are three different types of advance directives recognized in Washington state: a health care directive, a durable power of attorney for health care and Physician Orders for Life Sustaining Treatment.

A health care directive, or living will, is for situations of terminal illness with no hope of recovery, such as irreversible coma, for which treatment will artificially prolong life but not avoid death, and stopping treatment will allow a natural death. You and two witnesses who are not related to you and will not inherit anything from you must sign it.

A durable power of attorney for health care is for any medical situation in which you are unable to make your own decisions. It a legal document allowing you to authorize a person as your health care agent, someone who would have the same power as you to consent to, stop or refuse most medical treatment. This person should know what you would want in various situations. You and two witnesses must sign the form, preferably with a notary present.

The Physician Orders for Life Sustaining Treatment (POLST) form is relatively new in Washington. It helps people with serious illnesses to make their wishes known should they be faced with emergency medical situations requiring life support. The bright green form should be posted in a place where emergency personnel will see it, such as on a refrigerator or near a medicine chest, because it will be recognized as orders to be followed. The POLST form must be signed by both the patient and the attending physician, nurse practitioner or certified physician assistant.

Each of these three forms is separate and does not require the other two. The Washington State Medical Association (WSMA) recommends that everyone older than age 18 has a health care directive and durable power of attorney for health care.

Compassion & Choices of Washington, a nationally recognized advocacy group for choice for the terminally ill, and improved treatment of pain and other symptoms, offers a durable power of attorney for health care and health care directive. This combination form is detailed and allows individuals to use any portion of it to specify their wishes in particular areas.

LEARN MORE

All forms can be changed or revoked at any time, and are available free, by download at

wsma.org and

compassionwa.org or by mail.

The WSMA form for advance directives can be obtained by mail, with a self-addressed, stamped envelope (SASE) sent to WSMA, Attn: Advance Directive, 2033 Sixth Ave., Suite 1100, Seattle, WA 98121.

POLST forms are also available (include an SASE) at WSMA, Attn: POLST, 2001 Sixth Ave, Suite 2700, Seattle, WA 98121. Take the form to an appointment with your attending physician to discuss it and your wishes regarding life-sustaining treatment.

Compassion & Choices of Washington’s advance directive packet includes additional information about advance planning, including how to talk to your family about dying. It’s available at

compassionwa.org or by calling 877-222-2816 toll-free.

It’s not easy to deal with the death of a loved one. It’s not even easy to talk about when they’re in good health, but it’s worth it. When Margaret died, we knew just what she wanted. It was comforting to make that happen, and to focus on her. That was her final blessing.