End of Life — and Other Big Choices

Musicians' Assistance Program

Volume CV, No. 5May, 2005

Leslie Cardell, LCSW

Making end-of-life decisions is now front page news. Phrases like “health care proxy,” “advance directive,” and “living will” might be familiar to you now — although you might not know what they mean. Perhaps you made some resolutions in this area for yourself or family members, or maybe you found the whole subject just too confusing. But now might be a good time to consider what steps you would want to take.

Thinking about what could happen if we, or if someone we love, should become seriously ill is probably not on anyone’s list of favorite topics. So, it’s not surprising that most people haven’t filled out living wills or appointed anyone to make medical decisions for them should they ever become unable to do so themselves.

There are a lot of good reasons however, to face this uncomfortable task. Doing so can give you considerable peace of mind. You’ll know that your wishes are clear if ever you are unable to speak for your self. You’ll also know that the people who care about you won’t be put in the position of having to make serious decisions about your medical treatment when they don’t know, or can’t agree on what you would want.

So what is all this terminology?

An advance directive, as the name suggests, is a way of giving others direction about your wishes in advance of any medical crisis. Living wills and health care proxies (also called a health care power of attorney) are two different kinds of advance directives and can sometimes be combined.

A living will describes your wishes with regard to medical procedures that can delay death if you should have a terminal illness and are unable to speak for yourself. You can let doctors know if you would want treatments like a respirator, feeding tube or kidney dialysis if the situation became dire. New York State does not have a law that recognizes living wills, but the courts have set precedents, recognizing an individual’s right to decline life-sustaining treatment when this decision has been clearly indicated in advance in a living will. Since living wills must meet certain legal standards in court, it’s generally recommended that you consult an attorney.

A health care proxy allows you to appoint someone — usually a close friend or relative — to make medical treatment decisions for you, not only at the end of your life, but any time you’re unable to speak for yourself. This person can decide how your wishes apply as your medical condition changes. This person can also deal with questions of day-to-day care and treatment options short of “pulling the plug.”

While both of these documents can be important, it’s not always possible to predict what issues may arise during an illness.

A health care proxy knows you and can make decisions with your best interests in mind when something unexpected occurs. You can give the person you’ve chosen as little or as much authority as you want, and you don’t need to consult an attorney in order to appoint someone.

Because New York State does not consider artificial nutrition and hydration a medical treatment, you do need to explicitly state if you’ve given your proxy permission to make those decisions as well.

The Web site of New York State ( has downloadable forms for assigning a health care proxy, and instructions on completing them.

LSNJ Law ( has information and forms applicable to New Jersey.

Caring Connections, an organization involved in end-of-life planning, has forms on their Web site (, and can be reached at (800) 658-8898.

As always, please feel free to call us at the Musicians’ Assistance Program if you want more information. We have copies of health care proxy forms and instructions on completing them.

Leslie Cardell is a licensed clinical social worker and the coordinator of Musicians’ Assistance Program. MAP office hours are Monday, Wednesday and Friday from 9:30 to 5. Call (212) 397-4802 for an appointment.