End-of-Life Care

Planning Ahead

Would your family, close friends, or health care providers know what kind of care you would like to receive if, due to an accident or illness, you were unable to make health care decisions for yourself?

There are a few things that you can do now to make sure that you can still receive the kind of care you want even when you can not make the decisions for yourself:

TALK to your physician, relatives and friends about issues that are important to you. For example, under what conditions would you 1) not want to be revived if your heart stopped, or 2) not want to have machines breathe for you, or 3) not want to be given food and water to be kept alive if you could not eat or drink on your own? Keep in mind that oral communications alone may not be sufficient - a written direction may be more effective.

WRITE your wishes down. The document that contains your wishes regarding health care related matters is often called an advance directive. Some people may call this document a living will. In an advance directive, you can state your wishes about health care related issues and can also include wishes about organ donations, funeral arrangements and other matters that you would want your family, friends and health care providers to know about. Get more information about advance directives. It is important to give copies of any document that expresses your end-of-life care wishes to your doctor, your local hospital and any family members or friends who may be called upon to make decisions for you.

APPOINT someone you trust to make health care decisions for you when you no longer can. The person you designate (appoint) to make decisions for you is called your agent. The document in which you appoint your agent is called a durable health-care power of attorney. The durable health-care power of attorney can be contained in the same document as the advance directive.

The appointment of a durable health-care power of attorney must be done in writing. You and two persons, other than the agent you are appointing, must sign it. It is also wise to put the date you sign it on the document. The document that appoints your agent can be general or it can give your agent very specific directions on what decisions you want him or her to make when you no longer can make decisions. If it is general power, your agent will have to rely on what you told him or her about your wishes while you had the capacity to make decisions or the agent can rely on any advance directives contained in a separate document that you wrote while you could still make decisions for yourself. If you did not discuss health care issues in detail with your agent or write down your wishes in a separate document, your agent must make the health care decisions in your best interest, taking into consideration what she or he knows about you. See 18-A MRSA §§ 5-501, 5-506 and 5-802.

Your Children

Who would take care of your minor children (or your adult children who are not able to care for themselves), if you were terminally ill and the children's other parent were not available to care for them?

You should consider the following:

DELEGATE your authority as parent of minor children or as guardian of an adult child to another person for up to six months at a time by executing a power of attorney in accordance with 18-A M.R.S.A. § 5-104, and

EXECUTE A WILL that identifies a specific person to be appointed by the Probate Court as guardian of your children after your death. The statute requires the judge to give your choice priority so long as this is in the best interest of your children. For more information see 18-A M.R.S.A. §§ 5-202 and 5-204 and 5-311.

Pain Management

You or those you love do not have to end life suffering in pain. The Board of Licensure in Medicine and the Board of Osteopathic Licensure have rules that let physicians provide enough pain medication to terminally ill patients to make them comfortable without fear that the physician will be punished for doing so. For more information about these rules (Word, requires either Microsoft Word or the Word Viewer.)

If you believe that you or a loved one has not received adequate care or pain management from a licensed physician for a terminal illness, you may file a complaint with:

the Board of Licensure in Medicine (for M.D.s)
the Board of Osteopathic Licensure (for D.O.s)
the Board of Nursing

Hospice Care

Most people would like to die at home, in the company of family and friends and free of pain. In many cases, hospice care makes this possible.

Hospice care provides services to individuals and families during the process of dying and bereavement. Hospice care is meant to help meet the physical, social, psychological, spiritual and emotional needs of individuals and families during this very difficult time. The medical and non-medical services are delivered in the least restrictive setting possible. In most cases professionals, the family and volunteers provide these services in the home setting.

Hospice medical services focus on palliative care (control of symptoms and management of pain) rather than intensive, curative care. Hospice medical services are delivered by a team of individuals working with the individual's primary care physician.

The non-medical services are provided by a network of trained volunteers. Services can include transportation to medical appointments, respite care to allow family members to take brief breaks, and meal preparation.

There are over 20 hospice programs in Maine. To find out more about the location and services provided by these programs, you may contact the Maine Hospice Counsel at or 1-800-438-5963, or call Hospicelink at 1-800-331-1620.

Hospice care is a service that can be paid for by MaineCare or Medicare. To find out more about this, call the Department of Human Services, Office of MaineCare Services at 1-800-321-557 or 207-624-7539. View the MaineCare rules regarding hospice care (Word, requires either Microsoft Word or the Word Viewer.) You can also access Medicare regulations, 42 C.F.R. Part 418.

OFFICE INFORMATION