How to Write a Living Will

Guide Note

If you're unconscious, how will you tell your doctor that you don't want to be placed on a ventilator or, conversely, that you want him or her to use every means possible to preserve your life? These are the types of situations that a living will is designed to address.

This guide to How to Write a Living Will walks you through the process of creating a living will, helping you to document your desires about the types of medical care you would like to receive.

Table of Contents

• Introduction
• Step 1: Think About the Care You Want
• Step 2: Discuss Your Wishes
• Step 3: Get a Copy of Your State's Form
• Step 4: Complete the Form
• Step 5: Communicate
• Conclusion
• References

Living Will Tips

1. Don't procrastinate.
2. Everyone over 18 should have one.
3. Communicate your wishes to your family.
4. Living wills are state-specific.
5. Revise if you move.
6. Update annually.

Disclaimer

The content in this page is not a substitute for professional legal advice. Please contact your attorney before using the information presented here.

• by Susan MacDowell

Introduction

• A living will is a legal document that details the various types of medical treatments and life-sustaining measures you do and don't want under specific circumstances.¹ Some of the topics generally covered include mechanical breathing, tube feeding and resuscitation. Different states have different names for the document. You may also hear it referred to as a health care declaration, advanced directive or health care directive.²

Step 1: Think About the Types of Care You Want

(Photo by sanja gjenero)

• Although this is an uncomfortable topic to think about, if you avoid it, you won't have any input into your care. A living will speaks for you when you're unable to express your wishes.³ It also makes it easier on your loved ones if you leave them clear documentation of your beliefs. This list is not comprehensive, but here are some of the things to think about when considering what you'd like to include in your living will:

1. Circumstances
   1. You can precisely define the circumstances under which you'd like to receive or withhold care.
      • For example, you can state that you'd like all measures possible to sustain life as long as there's a chance that you'll recover, but still specify that you would not want specific procedures if there is no expectation of survival.
   2. You can decline life-prolonging procedures, but still request pain relief.^{4 5}
2. Cardiopulmonary resuscitation (CPR)
   • In most cases, if a person's heart stops, the standard of care is to attempt resuscitation by using CPR. Sometimes this has the result of leaving a patient alive, but brain dead. In cases of terminal illness, it is not unusual to determine that you do not wish to be resuscitated.⁶ This can be included in a living will, or with a separate stand alone Do Not Resuscitate (DNR) order.⁷
3. Mechanical Breathing⁸
   • A ventilator pumps air into a person's lungs through a tube in the person's mouth or nose. A living will can specify under what circumstances you would want that treatment, and if begun, under what conditions you would like the mechanical breathing terminated.
     

     (Creative Commons photo by Jeff Adair)
4. Artificial Feeding⁹
   • This includes techniques such as feeding through a tube that passes through the nose to the stomach, or the surgical insertion of a tube directly into the stomach. Nutrition can also be delivered on a short term basis through an IV tube. You can accept or decline any or all of these methods, as well as specify when and for how long each would be acceptable.
5. Intravenous Fluids¹⁰
   • Intravenous fluids are given to prevent dehydration.¹¹ Although IV Fluids are generally not considered "extraordinary measures," you can detail the circumstances under which you would not want to receive Intravenous Fluids in your living will.^{12 13}
6. Antibiotics
   • In some cases of terminal illness, you might wish to decline antibiotic treatment if you contract a potentially fatal (but treatable) condition such as pneumonia.¹⁴

Consult Your Doctor

• You'll want to discuss your decisions with your doctor. In addition to making sure they understand your wishes, they'll also be able to give you input on what types of issues your living will should address.³

Power of Attorney for Health Care

• In addition to a living will, you should also have a durable power of attorney for health care (sometimes referred to as a health care proxy), which appoints someone to make health care decisions for you, if you can't.¹⁵ This is essential because, try as you might, your living will won't be able to anticipate every possible situation.

• The National Hospice and Palliative Care Organization provides downloadable state-specific forms for appointing your health care proxy.¹⁶

Step 2: Discuss Your Wishes with Your Loved Ones

(CC photo by j. botter)

• After you have an idea of the types of treatment you want and don't want, its time to discuss your wishes with your family members.¹⁷

1. You want to get their input, as well as share your thoughts.
2. Listen to their opinions.
3. Make sure to include extended family members as well.
   • If your parents and spouse disagree, for example, its important to make sure that all parties understand what you would like to avoid unnecessary conflict and tension during a trying time.¹⁸
4. You may also want to include your clergyman in the discussion.

Step 3: Get a Copy of Your State's Living Will Form

• Each state has specific requirements, and you want to make sure that your living will meets the legal requirements of your state.

• Because there is no national standard, you'll want to execute a new living will if you relocate from one state to another.

1. Obtain your state's living will form from your state health department, local hospital, doctor or the local council on aging.¹⁹
2. Caring Connections, a service of the National Hospice and Palliative Care Organization, has downloadable living will and medical power of attorney forms for every state available online.¹⁶
3. You might also prefer to work with a lawyer, executing a living will in conjunction with a Last Will and Testament or estate plan.

Step 4: Complete and Execute the Form

1. Review the form carefully, making sure you complete all sections.
2. Add additional details if there are specific wishes you have about your care that the form doesn't cover.
3. Sign the living will form and get it witnessed according to your state's laws.¹ An improperly signed or witnessed living will may be ruled invalid.

Step 5: Communicate

• If you complete the form, but nobody knows about, it won't be used when the time comes.

1. Give family members copies of the completed form.
2. Give a copy to your doctor and to your lawyer.
3. Keep a copy with your personal important papers.

Conclusion

• Hopefully, this is a document that will never be needed. If it is needed, you will have assured that your wishes will inform the care you receive, as well as having eased a burden for your loved ones. This is not a document you can store and forget about, however. Medical technology is evolving, introducing new treatments that you may or may not want. Additionally, personal circumstances and beliefs change over time. Its a good idea to review your living will annually, around the time of your annual physical.¹ That way, you can ensure that your doctor always has the most up to date information.

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References for How to Write a Living Will

1. ↑ ^{1.0 1.1 1.2} American Bar Association: Living Wills, Health Care Proxies, and Advance Health Care Directives
2. ↑ Wikipedia: Advance health care directive
3. ↑ ^{3.0 3.1} HelpGuide.org: Advance Health Care Directives and Living Wills
4. ↑ NOLO: Life-prolonging procedures
5. ↑ Hospice Foundation of America: Pain through the Ages
6. ↑ Mercy Hospital and Medical Center: Guidelines for Application of CPR in Patients with Terminal Illness
7. ↑ Wikipedia: Do note resuscitate
8. ↑ Wikipedia: Mechanical Ventilation
9. ↑ Completing a Life: Artificial Feeding
10. ↑ Wikipedia: Intravenous therapy
11. ↑ Family Caregiver Alliance: End-of-Life Choices: Feeding Tubes and Ventilators
12. ↑ unbossed.com: What constitutes "extraordinary" measures?
13. ↑ National Guideline Clearinghouse: Dehydration and fluid maintenance
14. ↑ Completing a Life: Antibiotic Treatment
15. ↑ MayoClinic.com: Living wills and advance directives: Tools for medical wishes
16. ↑ ^{16.0 16.1} National Hospice and Palliative Care Organization: State Advance Directives Downloads
17. ↑ BaltimoreSun.com: Create your living well, then be sure to discuss it (March 27, 2005]
18. ↑ Columbus Business First: Discuss living will with loved ones (July 20, 2007)
19. ↑ StatePublicHealth.org: Public Directory