Unexpected Answer

Having heard horror stories about marriage breakups, I would assume that one of the first things to be cancelled would be an advance medical care directive, where one party can make a life-or-death call on the ex-spouse.

The WSJ advice columnist gives an unexpected answer. [bold added]

Now I’ve discovered that my advance medical directive still has my ex-wife listed as my healthcare proxy. Should the situation arise, she can decide whether to keep me alive or disconnect me from life support. Should I find somebody else to take over this role?--Alec

You should certainly keep your ex-wife as your healthcare proxy, and not simply out of convenience or a desire to avoid giving offense.

The doctor and medical writer Jerome Groopman has observed that it is often better for doctors not to like their patients. Why? Because it is difficult to be objective in making decisions for people we are attached to. We make more judicious decisions regarding people we care about less.

In your case, your ex-wife doesn’t care much about you these days. And because of that, should you sustain a serious injury or illness, the odds are in your favor that she will make more rational decisions on your behalf than she would have done during the days when she loved you deeply. Even if you do end up getting remarried, keep her as your healthcare proxy. There is no substitute for the rational coldness that comes from having your ex-wife make decisions for you.

This being said, don’t tempt her too much: Make sure she is not one of the beneficiaries of your will or life insurance.

It's possible for a person to decide that he or she can no longer live with the spouse, yet still believe that the other has integrity and judgment. If there's some trust remaining--as one might have with an intimate friend--and there's some distance between the divorce and the fateful decision, then one can leave the directive in place.

Nevertheless, there are many things that can go wrong, and my advice would be to change it.