Season 3 Episode 56: Living Will Preparation: Do the Thinking Before the Forms (Part 1 of 3)

Let me tell you about Simone.

She's 28 years old with a husband and two young children. After a car accident, she has severe brain damage and is in a permanent vegetative state. The doctors inform her family that she'll never regain consciousness again.

But because she's young and otherwise healthy, she could live for years with a feeding tube.

Her family is facing an impossible decision: Should they keep her on life support indefinitely or would Simone have wanted to be allowed to die naturally?

The problem? They're guessing.

Because Simone never told them what she would want.

(This story comes from the Emory Critical Conditions Planning Guide, which we'll talk about in detail today.)

The Real Problem with Advance Directives

Here's what happens to most people:

They download the living will form. They start filling it out. Then they hit a question like "If you have a terminal condition, do you want life sustaining treatment discontinued?"

And they freeze.

Because they've never asked themselves: What IS life sustaining treatment? How do I feel about that? What would I want?

So the form sits there. Half filled out. For weeks. Months. Sometimes years.

Meanwhile, they have no protections in place.

That's what we're preventing today.

Forms vs. Preparation

In today's episode, we're not asking you to fill out your living will yet. We're doing something more important: the thinking work that comes BEFORE the form.

Because here's the thing about these legal documents (and yes, they're available free in Texas and many other states): they're actually pretty straightforward.

The hard part isn't the form itself.

The hard part is knowing what YOU want.

What We're Covering Today

In this first part of our three-part series on living wills, we walk through:

• What advance directives actually are (spoiler: it's more than one form)
• The two main scenarios you'll face on the form: terminal vs. irreversible conditions
• Specific treatments you need to understand: feeding tubes, ventilators, CPR
• The values questions that will guide your decisions
• Why the Emory Critical Conditions Planning Guide is essential prep work

Terminal vs. Irreversible: Know the Difference

The Texas living will asks you to make decisions about two different scenarios:

A terminal condition means an illness or injury where, even with treatment, doctors expect you to die within six months. Think cancer that has spread and isn't responding to treatment, end stage heart failure, or advanced lung disease.

The question becomes: Do you want those treatments that might give you extra weeks or months, even though they can't cure you?

An irreversible condition is different. This means a condition that can be treated but never cured. In some situations, you can't care for yourself, can't make decisions, and without life sustaining treatment, you would die.

Think advanced dementia where you don't recognize anyone and can't communicate. Or a permanent vegetative state after a brain injury. You could be kept alive for years with feeding tubes and other treatments, but you won't recover your ability to think, communicate, or care for yourself.

The question: In that situation, would you want the treatments that keep you alive, or would you want to be allowed to die a natural death?

Santiago's Story

Sometimes understanding these treatments becomes very personal.

Before Santiago was treated for cancer, the doctors asked if he wanted a feeding tube installed. "It's easier to do it before you start going through treatments," they said.

He said yes. Just in case.

The radiation severely affected his throat to the point where he couldn't swallow anything. Without that feeding tube, he probably wouldn't have survived.

It saved his life.

But here's the thing: that was a temporary situation with the possibility of recovery. If the situation had been different, if recovery wasn't possible, would he have wanted the same intervention?

That's the kind of thinking you need to do.

The Values Work

Before you can meaningfully complete your living will, you need to wrestle with some core values questions:

What makes your life worth living? Is it being able to recognize your loved ones? Communicate? Walk independently? Be mentally sharp? There's no right or wrong answer, but you need to know YOUR answer.

How important is independence to you? If you reach a point where you need round-the-clock care, can't breathe on your own, can't feed yourself, can't make decisions, how would you feel about that?

What role does your spirituality or religious beliefs play? Some believe life should be preserved at all costs. Others believe that when death is inevitable, we should allow natural death without prolonging the process artificially.

What are your fears about end-of-life care? Being in pain? Being a burden on your family? The costs of care eating into what you plan to leave? Being stuck somewhere where no one can visit you?

When you know what you're most worried about and what you most fear, you can make decisions NOW that address those concerns.

Why Emergency Docs Need to Be Clear

Here's something we learned from estate planning attorneys: When you get to the actual form, be succinct.

Why? In an emergency, doctors can't read a book. They're focused on saving your life, and time is of the essence.

Your wishes need to be clear. A quick read is best. That's why these forms have checkboxes.

The Texas form does have one section where you can add additional notes (things like organ donation preferences), and you can attach addendums if you want more detail.

But the key is: clear, concise, easy, and quick to read.

The Emory Guide is where you take all the time you need. Work through it thoughtfully. Think deeply. Write out your reasoning.

Then, when you fill out your legal form, you'll be able to distill all your thoughts into clear, concise instructions.

We've Changed Our Minds (And That's Okay)

Being in our third year of doing this podcast and working through these documents ourselves, we've changed our positions on some things. Both of us have.

I might not agree with what Honey wants from my perspective, but that's what she wants. And that's what I'm going to do for her. She's going to do the same for me.

If you want that kind of clarity and trust, take your time with the Emory Guide. Let your decisions reflect your values.

And remember: this isn't permanent. As you grow and your life changes, you might change your mind. That's completely normal.

Real Life Can Teach You Too

It's not just the Emory Guide that can help you clarify what you want.

Sometimes you hear in the news or read an article about a celebrity who has passed or had a terrible accident and is now incapacitated. Observing their situation could be helpful to you.

You can put yourself in their shoes and think: What would I do? Would I do the same thing? What would I want?

The Emory Guide is definitely your foundation, but everyday real life can be instructive too.

Your Action Steps Before the Next Episode

Here's what we want you to do:

1. Download and work through the Emory Critical Conditions Planning Guide. Take your time. Don't rush. You don't have to complete it in one sitting. This is deep, personal thinking.

Set aside quiet time. Maybe journal about the questions. Talk with your spouse if you feel comfortable. Or email us at [email protected] if you have questions.

Pray on it. Meditate on the questions if that's part of your process. The point is to really think about your answers.

It's okay if you don't have an answer right away. Read the question, think about it, come back to it later, then write your answers down.

When you download the guide, you'll see 44 pages. Focus on the first 26 pages for the most important work.

2. Start thinking about who you might want to be your healthcare agent or advocate. This is the person you would trust to speak on your behalf if you can't speak for yourself.

You don't need to approach them yet. Just keep someone in mind. Actually, keep TWO people in mind: a primary and a backup.

We'll do a complete episode on the medical power of attorney where we'll walk through how to select this person, what their role is, and how to have the conversation when you ask them.

But for now, just think about who in your life really understands you, knows you, knows what you want, and would honor your wishes even in a crisis, even if it hurts them.

Why This Preparation Work Matters

A lot of people want to skip this part and just jump into the form, check some boxes, and be done with it.

I get it. It's very uncomfortable to think about these scenarios. It's easier to just check a box.

But here's the thing: If you skip the values work, if you skip the scenarios, you might not capture what you really want.

You haven't really thought through what matters to you, what quality of life means to you, what you would and wouldn't want.

And those things are important.

Yes, it's uncomfortable. But it's also one of the most important documents you're ever going to complete.

It deserves thoughtful preparation.

Because without that foundation, you're just filling out a form. They're just words on paper.

But when the preparation work is done, the forms become meaningful. They truly express your wishes.

And that's what makes the difference for your family.

What's Next

In our next episode (Part 2), we're going to talk about the optional addendums you might want to consider for your living will. These are additions that some people find very helpful, but they're not required.

We'll help you understand what addendums are available and how to decide if any of them make sense for you.

Resources

📋 START HERE: Emory Critical Conditions Planning Guide

Texas Advance Directives (reference only - complete the Emory Guide first): Texas Health and Human Services

For listeners in other states: Search "[your state] advance directives" and look for official .gov websites

Listen to the Full Episode

Find "Thoughtful Planning" on Apple Podcasts, Spotify, iHeart Radio, Amazon Music, and Pandora.

Remember: Every chapter you write today shapes your legacy tomorrow.

Have questions? Email us at [email protected]