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End of Life Care

There are a great many care options for the last days of life. Emotional and philosophical concerns, deciding where to receive care, and legal documents (such as advance directives, a health care proxy, and a living will) need to be discussed, decided, and legally secured to ensure you receive the treatment you want.

By Dianne B. Scheinberg, MS
November 23, 2005

Medicine today has the power to prolong life in two different ways. Many of us will live longer and fuller life spans because of medical advances, lifesaving interventions, and new prevention knowledge. Others of us will find our last days and months prolonged—sometimes in an unwelcome way—by life support technology and practices that enhance neither the quality of our lives nor our deaths.

Life support can breathe for us, eat for us, and substitute for vital organs. Sometimes a partial (or full) recovery from a terminal illness or incapacitated state is possible; but even when there is no hope of revival, doctors may sometimes take extraordinary measures. Some say that these choices derive from doctors' training in resisting death at any cost, others point to liability risks if any potentially curative intervention is overlooked. But increasingly, doctors, along with patients and family members, fail to recognize when curative technology is no longer indicated and a different technology—end of life care—should be brought into play.

Talk of dignity, quality, and sanctity of life has been heard ever more frequently in hospitals, medical schools, and the media. These terms have different meanings for each of us, and can sometimes be used as arguments for or against life support. At the same time, dignity and quality of life are important to all of us, especially when we are very ill and potentially near the end of our lives. So who should decide what care is life-saving as opposed to death-prolonging? You.

There are a great many considerations to end of life care, including: emotional and philosophical concerns, deciding where to receive care, and legal options. The one thing that everyone agrees on is that each of us should ponder, discuss, and legally establish our approach to the management of life-threatening illness before a medical crisis occurs.

Emotional and Philosophical Matters

You can begin by asking yourself some tough emotional questions. What are your fears: pain, loss of dignity, machines keeping you alive, or dying in a strange place? Fill in the blank: "My life is only worth living if I can ___". Is life defined by a heart beat or a working brain? Whom do you want to make decisions for you if you are not able to communicate? Discuss options with your doctor. Seek guidance from your religious leader. Talk with family. Above all, make sure that family members know what your choices would be under a variety of serious situations; if possible, put your choices and values into writing.

Care Options

The last days of life can be spent in your home, a nursing facility or a hospital. These facilities generally seek to cure, rehabilitate, or support life. If you are seeking curative care or aggressive medical treatment, a hospital is usually the best choice. Today many hospitals are adept at balancing curative and palliative care when the end of life approaches. Palliative care, perhaps most often given in the hospice setting, provides treatment that enhances comfort and quality during the last days of life. This type of care seeks neither to hasten nor to postpone death, but rather to provide relief from pain and discomfort. While services may vary from community to community, in many parts of the country palliative care can be supplied either in a hospice facility or in your home.

Legal Options

For most of us it is very hard to imagine how we are likely to feel when faced with a serious and potentially fatal illness or injury. It is perhaps only human nature to prefer to wait until the crisis is upon us and then communicate our intentions to the nurses and doctors providing our care. Unfortunately, there are many scenarios that can interfere with one's ability to communicate. For example, it is impossible to tell a doctor your treatment decision while on a ventilator (mechanical breathing apparatus) or when unconscious. Fortunately, there are legal solutions to this problem. Among these legal solutions are:

  • Advance directives
  • Health care proxies
  • Living wills
  • Do not resuscitate orders

Here is some information about each of the above:

Advance directives are written legal documents that state your wishes if you can no longer speak for yourself. With these documents in place, medical personnel and loved ones don't have to guess what you would prefer or make decisions you would not want for yourself.

A Health Care Proxy names someone to make medical decisions for you when you are not able to make such decisions. This person should be someone you trust, who knows what treatments you would want or would reject, and who will respect these preferences. Your proxy does not have to receive specific instructions from you and can make decisions as if she or he were in your situation, but conscious and able to communicate.

A Living Will states your requests regarding life-sustaining medical treatment (for example, a feeding tube, breathing tube, or surgery) and is only effective if you are unable to communicate. These instructions for treatment or refusal of treatment can be made as broad or specific as you wish. For example, you can ask that your life be prolonged as long as possible whatever your state of consciousness, or you can state that you do not want extraordinary treatment to maintain life if as a result you will need constant care or not have an existence that seems of adequate quality to you. You can also address specific circumstances that commonly arise at the end of life (dementia, trauma, or coma).

A Do Not Resuscitate order instructs medical personnel not to bring you back to life if you stop breathing or your heart stops.

Each of these four legal solutions requires that you complete a document that will become part of your personal medical file. This way, you or your family members can ensure that, in the event of a hospitalization, all of your caregivers know about your written wishes and incorporate them into your care plan. For further information, you can talk to a lawyer, explore the numerous books written on this topic, or use the internet resources listed below.

It is important to note that advance directives are not iron clad, and no single one of the four choices above can anticipate every situation that may occur at the end of life. Since it is difficult to anticipate every medical possibility, a living will might not precisely address what actually happens to you. Additionally, no matter how carefully you try to think about what might happen to you as you write your living will, you still run the risk of this document being misinterpreted by doctors or family. So, even with a living will in place, it is still essential to have someone you trust—preferably named as a health care proxy—to make decisions for you in the case of unforeseen circumstances. Your proxy should know you well and spend considerable time discussing your philosophies, expectations, and values. Combining a living will with a designated proxy is a particularly smart way to prepare for your end of life care.

No one wants to think about the unpleasantness of life-support: whether its end result is to prolong our lives or to prolong our deaths. But when life support no longer offers hope of quality living, decision must be made. No one can make such decisions better than you. Choose your options while you can speak for yourself. The questions are tough, but the issues are life and death: yours.


Create your Will, Power of Attorney and Living Will online at https://www.legalwills.ca/.


For More Information Contact:

LegalWills.ca
Email: [email protected]
Internet: https://www.legalwills.ca/

How It Works

When you create a Will or legal document at LegalWills, you can designate up to 20 different Keyholders®. Your chosen Keyholders® will be given the trust and power to unlock specific information within your account such as health care directives, funeral wishes, final messages, uploaded files, Power of Attorney, or Last Will and Testament.

You can also implement security mechanisms to prevent premature access to these documents. The entire process of creating your Will and other legal documents at LegalWills is seamless and iterative, meaning you can continue to make changes until you're happy with the final product.

Create Your Documents in Five Easy Steps

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Creating your documents is quick and easy with LegalWills. Simply fill out the required fields and proceed to the next step.

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Select Your Keyholders®

Entrust up to 20 individuals to unlock your wishes when the time is right.

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Edit Your Documents for Up To One Year for Free

Make any changes to your documents using our online service.

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Keyholders® Request Access

When the time is right, your selected Keyholders® will have the ability to unlock your wishes.

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Documents are Released to Keyholders®

When the time comes and your Keyholders® request access to your documents, your wishes will be entrusted in their hands.

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Frequently Asked Questions

There is no requirement to use the services of a lawyer or notary public to prepare your own estate planning documents, including your Last Will and Testament.

The law that defines the legality of a Will is written specifically for each Province, State and Country, but in summary the law requires that the Will is written on a piece of paper and signed in the presence of two witnesses who cannot be beneficiaries to the Will.

Lawyers can certainly help you to prepare your Will, but everybody has a legal right to write their own Will. If you create a document using our service, it must be printed, signed and witnessed according to our instructions, and then it becomes a legal Last Will and Testament.
Quite simply, because we do not provide you with legal advice.

We are giving you direct access to the same software that lawyers use to prepare their documents, but you are doing it yourself. However, if you need custom clauses written to cover an unusual situation, we cannot do that, and we recommend that you seek legal advice. For example, if you have a child with special needs, they would need a trust written for their inheritance. We don't do that.

In most cases, a document written using our service will be word-for-word identical to one prepared by a lawyer.

For a more thorough explanation, please read our blog article: The Cost of a Will in Canada – Explained.

There are no other payments required to prepare your legal Will. You can have a legal Will in your hands for $49.95CAD with nothing else to pay, ever.

What other options are there?
If you wish, you can have your Will reviewed by one of our lawyers for $69.00CAD. Most people do not need this, and would not benefit from it, but if you have selected an option such as "None of the above. Let me describe in detail how to distribute my estate.", then you may want to consider this. (Currently not available in Ontario.)

Your Will must first be printed, and then signed in the presence of two witnesses. If you do not have access to a printer, we can print it for you and mail it out. The cost for this is $9.95CAD, but again, most people do not need this option.

We also offer other services like MyLifeLocker™, a Financial Power of Attorney, and a Living Will. They are not required, but they may be useful to you depending on your situation.

What about document storage?
We do not store physical documents, but we allow you to maintain an account with us if you want to update your document in the future.

The Will service costs $49.95CAD. With this payment, you are able to prepare your Will. It also gives you one year of unlimited updates to the document. You are able to print the document as often as you wish during that first year. You can download it as a PDF or Word file, but to make your document a legal Will, it must first be printed, and then signed in the presence of two witnesses. The online version is there for your convenience only.

If you choose not to maintain an account with us after the first year, your initial payment is all you will ever pay. We do not keep credit card details on file and cannot automatically charge beyond this initial payment.

If you wish, you can choose to store your documents online for longer than a year, which will make it easier to make updates in the future to reflect any changes in your personal or financial situation (rather than returning to a lawyer each time). This is of course optional, but it does make the process of maintaining your document more convenient. $11.95CAD will give you one additional year of updates, or you can purchase multiple years: 5 years at $29.95CAD, 10 years at $39.95CAD, 25 years at $79.95CAD ($3.20CAD per year).

Every time you make an update to your Will, it must first be printed, and then signed in the presence of two witnesses again. If you choose not to maintain an account with us, you will always have your printed, signed document. If you don't need to make changes to that document, it will last you for the rest of your life, whether or not you have an account with us.

What happens if I don't maintain an account, and then in a few years I need to update it?
If your account has not been touched in years, and it is inactive, we reserve the right to remove the account. You will receive an email notification that your account might be removed. However, in practice, we have never actually removed any accounts in our over 25 years of operation.

So, in all likelihood, you will be able to simply login to your account and pay $11.95CAD to reactivate it. This will give you one year of unlimited updates from the date of payment. (You will not have to pay for your inactive years.)

Yes.  A Power of Attorney (also known as a Power of Attorney for Finances) and Living Will (also known as a Power of Attorney for Health Care), are very important documents that should be created and updated at the same time as your Will.

This website allows you to create a Will, Expatriate Will, Power of Attorney and Living Will .
Here are just a few differences:

  • We have designed our legal document creation services to be of the best quality available today.    We have evaluated many existing do-it-yourself kits and web-based services, including several of the most popular Canadian legal will kits. We were shocked by the poor quality, limited instructions, and low value for money that many of these do-it-yourself kits provide consumers. 

  • Incredible value for money.   Our membership pricing model allows us to provide you with the most value for your money at prices that are unprecedented in the legal industry. We worked with lawyers to bring you this service, and we paid for their legal services so you don't have to. 

  • Plain language help and instructions.  In addition, all of our services provide you with complete instructions and answer your questions in everyday language, free of legal industry jargon.  We have developed our services based on the requirements of the public, not dictated by the legal profession.  Our wizards, help and information are also designed to be the best on the market and are kept up-to-date on an ongoing basis.  

  • Create your Will from the comfort of your own home.  No lawyer required.  Our unique approach allows you to make use of the ultimate convenience of the Internet to write your Will at your own pace, online, and to make changes online at any time free of charge. 

  • Free unlimited updates.  Don't pay a lawyer every time you need to update your Will. We allow your Will to be kept securely online so that you can make free unlimited updates for as long as you are a member.

  • You can still have it reviewed by a lawyer. We have worked with lawyers in Canada to bring you these services and to ensure that they are of the highest quality. But if you wish, we can still arrange for your documents to be reviewed by one of our lawyers, who will check the documents for consistency and completeness. (Currently not available in Ontario.)

  • The Keyholder® Advantage. You can take advantage of our unique messaging service which allows you to describe the exact location of your Will and to provide a detailed list of assets for your Executor. All for no extra charge. When you pass away, let us worry about communicating this information to the people you specify. There is simply no other company that provides such a complete and convenient service to their customers. For more information, read about The Keyholder® Advantage .

  • We employ a strong focus on protecting the privacy and security of your information.   We use industry standard encryption algorithms for storing all of your private information, and the design of our services ensures that the contents of your information are made available to the specific people designated by yourself, and only at the appropriate time. 

  • Keep informed and up to date.  If you wish, we can inform you by email about any changes in legislation which may have occurred in your jurisdiction that may require changes to your Will.  Or we can send you simple email reminders, no more than once a year, to remind you to consider updating your Will if any significant changes have occurred in your life.  

Other websites and do-it-yourself kits simply do not compare.

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