Now that our children have graduated from college, started graduate school, finished graduate school, or are entrenched in their careers, their need for a Health Care Proxy, Living Will and HIPAA Authorization is even more paramount. We might recognize the need for such documents for ourselves as parents; after all, we owe it to our children to reduce the foreseeable stress that will accompany our aging. However, the very same documents are also important for our now-adult children, especially when they do not live under our roof and/or are geographically distant. Our children’s lives and personal philosophies about relationships, life and death have changed so dramatically from when they first officially became adults (In Massachusetts the age of majority is 18) to today. As tough as it can be to accept, they are independent adults. As such, they may not want their parents making critical decisions for them anymore. They may have “significant others” or “best friends” or even close siblings/cousins in their lives who they would want to depend upon to carry out their wishes in serious health-related circumstances.

Let’s make certain we understand each of these documents and why they are so important:

A Living Will, also known as an advance medical directive, is a document that outlines the medical decisions you want in case you are unable to communicate them. A Health Care Proxy, a document that often accompanies a Living Will, names the person you want to make health care decisions for you (known as an agent) in case you are incapacitated. Essentially, the Living Will states what you want to be done and the Health Care Proxy identifies who you want to carry that out. A HIPAA Authorization —the acronym refers to the Health Insurance Portability and Accountability Act, the law governing medical data privacy — is a document that allows any appointed person or party to share/receive specific health information. Without this document, family members, friends and significant others have no access to your health information. As a side note:
in the Commonwealth of Massachusetts, currently, the Living Will is not recognized as a binding document; but, when presented to a Court by your Health Care Agent, the Living Will clearly indicates to the Court what your intentions were when you were fully functional.

Your child may think that having these documents screams: “I am not that old; I am not dying; I will never need them!” The problem with this rationale is that, while statistically sound and very reassuring, if they are needed and have not been drawn up, the consequences could be potentially devastating. Writing a Living Will is not pleasant to think about, but it ensures that the owner of that Living Will, if incapacitated, receives the treatment that s/he wants. In other words, the course of treatment incorporates your child’s wishes.

Conversely, if your child has not completed a Health Care Proxy, someone may be asked to make decisions based upon what they believe your child would want done. You might want to encourage your child to figure out his/her preferences for medical treatment, pointing out, for example:

• If your heart stopped beating, would you want CPR or defibrillation, which administers an electric shock to the heart?
• If you were unable to breathe on your own, would you want assistance from a breathing machine?
• If you were unable to eat or drink, would you want feeding tubes to supply your body with nutrition and fluids, and/or dialysis to remove waste from your blood and manage fluid levels?
• Would you want to donate your organs and tissue for transplantation or scientific study?

Because a Living Will raises questions that aren’t necessarily easy to answer, one must discuss these questions with a Health Care Agent before naming someone. Also, if your child practices a religion that has a particular stance on certain treatments, this consideration is equally important. When selecting a Health Care Agent, you should encourage your child to choose someone s/he thinks will act honestly and maturely, with your child’s interests at heart (not someone your child feels obligated to ask). This can be a family member, friend or outside adviser who is able to make thoughtful decisions.

Times have truly changed, and it is not unusual to be involved in a long-term relationship with a “significant other” to whom one is not legally married. This person with whom your child is sharing his or her life will not be entitled to receive any medical information unless s/he has been named in a HIPPA authorization. A well-drafted HIPPA authorization will allow your child to name several individuals, if desired.

A philosopher I once knew stated: “Maturity is tough!” Please contact me if I can assist you or anyone you know.