A living will, also known as an "advance healthcare directive", is a legal document in which a person specifies the type of medical care that they do or do not want to receive in the event that they are unable to communicate their wishes. In other words, living wills provide legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself. These advance directives guide choices for doctors and caregivers if you are terminally ill, seriously injured, in a coma, in the late stages of dementia, or near the end of life.
Living Wills Direct End-of-Life Care
A living will outlines your healthcare choices in relation to a number of different medical scenarios. In determining your wishes, think about your values. Consider how important it is to you to be independent and self-sufficient, and identify what circumstances might make you feel like your life is not worth living. Would you want treatment to extend your life in any situation? All situations? Would you want treatment only if a cure is possible?
You should address a number of possible end-of-life care decisions in your living will. Decisions you will need to make may include:
Determine if and when you would want to be resuscitated by CPR or by a device that delivers an electric shock to stimulate the heart. CPR or cardiopulmonary resuscitation restarts the heart when it has stopped beating.
Consider if, when, and for how long you would want to be placed on a mechanical ventilator. Mechanical ventilation takes over your breathing if you are unable to breathe on your own.
Decide if, when, and for how long you would want to be fed via a tube feeding. Tube feeding supplies the body with nutrients and fluids intravenously or via a tube in the stomach.
Determine if, when, and for how long you would want to receive dialysis. Dialysis removes waste from your blood and manages fluid levels if your kidneys no longer function.
If you were near the end of life, would you want infections to be treated aggressively or would you rather eat infections run their course? Antibiotics or antiviral medications can be used to treat many infections and come into question in a living will when discussing end-of-life care.
Determine if you want to receive comfort care. Comfort care or palliative care includes any number of interventions that may be used to keep you comfortable and manage pain while abiding by your other treatment wishes. This may include being allowed to die at home, getting pain medications, being fed ice chips to soothe mouth dryness, and avoiding invasive tests or treatments.
Determine if you want to donate your organs and tissues. Organ and issue donations for transplantation can be specified in your living will. If your organs are removed for donation, you will be kept on life-sustaining treatment temporarily until the procedure is complete. To help your heath care agent avoid any confusion, you may want to state in your living will that you understand the need for this temporary intervention.
Decide if you want to donate your body for scientific purposes. You and/or your attorney helping you with your living will must contact a local medical school, university, or donation program for information on how to register for a planned donation for research.
In essence, a living will addresses all the life-sustaining measures that you may face at the end of life or near end of life. Keep in mind though, that a living will only takes affect if the patient is unable to make decisions or communicate their wishes when care is needed.
Do Not Resuscitate and Do Not Intubate Orders
It is worth noting that you do not need to have an advance directive or living will to have a "do not resuscitate" (DNR) and "do not intubate" (DNI) orders. To establish a DNR or DNI order, tell your doctor about your preferences. He or she will write the orders and put them in your medical record.
Even if you already have a living will that includes your preferences regarding resuscitation and intubation, it is still a good idea to establish DNR or DNI orders each time you are admitted to a new hospital or health care facility.
Importance of a Living Will
A living will is important no matter the persons age. It is important that your family members and care providers know your preferences for end-of-life care. When you have a Living Will, you're making your wishes clear. It is difficult to think about potentially devastation disputations, but preparation is key. If you do not put your choices in writing, your family members will be forced to make the tough decisions for you. By you creating a Living Will, you take the burden off your family and get to make the decision of what happens up to the very end.
Once the Living Will is Completed
When you have completed your Living Will, you need to do the following:
Keep the originals in a safe but easily accessible place. This may be a safe that you and your spouse have access to or a safety deposit box.
Give a copy to your doctor.
Give a copy to your health care agent and any alternative agents.
Keep a record of who has your advance directives.
Talk to your family members and other important people in your life about your advance directions and your health care wishes. By having these conversations now, you help ensure that your family members clearly understand your wishes. Having a clear understanding of your preferences can help your family avoid conflict and feelings of guilt.
Carry a wallet-sized card that indicated you have a Living Will or advance directives. This card will identify your healthcare agent and state or states where a copy of your directives can be found.
Keep a copy with you when you are traveling.
Reviewing and Changing Advance Directives
You can change your directives at any time. If you want to make changes, you must create a Living Will, distribute new copies, and destroy all old copies. You should discuss changes with your primary care doctor and make sure a new directive replaces an old directive in your medical file. New directives must also be added to medical charts in a hospital or nursing home. Also, be sure to talk to your healthcare agent, family, and friends about changes you have made.
Consider reviewing your directives and creating new ones in the following situations:
New diagnosis. A diagnosis of a disease that is terminal or that significantly alters your life may lead you to make changes to your Living Will. Discuss with your doctor the kind of treatment and care decisions that might be made during the expected course of the disease.
Change of marital status. When you marry, divorce, become separated or are widowed, you may need to select a new healthcare agent.
About every 10 years. Over time your thoughts about end-of-life care may change. Review your directives from time to time to be sure they result your current values and wishes.
The process of planning a living will is not an easy one. It can be extremely emotional and is something that should never be rushed. Given the emotional toll and the numerous situations one must consider, it is highly advised that you work with an attorney when drafting a Living Will.
If you or someone you care about find yourself in a situation where you are looking to draft a Living Will or any other estate planning documents, please feel free to reach out. The Rose Law Firm would be honored to help ensure that you are not alone when wading through the emotional toll and that your wishes are spelled our clearly and concisely.