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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.
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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.American Bar Association: Living Wills, Health Care Proxies, and Advance Health Care Directives 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.Wikipedia: Advance health care directive
Step 1: Think About the Types of Care You Want
- 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.HelpGuide.org: Advance Health Care Directives and Living Wills 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:
- Circumstances
- 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.
- You can decline life-prolonging procedures, but still request pain relief.NOLO: Life-prolonging procedures Hospice Foundation of America: Pain through the Ages
- You can precisely define the circumstances under which you'd like to receive or withhold care.
- 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.Mercy Hospital and Medical Center: Guidelines for Application of CPR in Patients with Terminal Illness This can be included in a living will, or with a separate stand alone Do Not Resuscitate (DNR) order.Wikipedia: Do note resuscitate
- Mechanical BreathingWikipedia: Mechanical Ventilation
- 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.
- 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.
- Artificial FeedingCompleting a Life: Artificial Feeding
- 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.
- Intravenous FluidsWikipedia: Intravenous therapy
- Intravenous fluids are given to prevent dehydration.Family Caregiver Alliance: End-of-Life Choices: Feeding Tubes and Ventilators 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.unbossed.com: What constitutes "extraordinary" measures? National Guideline Clearinghouse: Dehydration and fluid maintenance
- 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.Completing a Life: Antibiotic Treatment
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.MayoClinic.com: Living wills and advance directives: Tools for medical wishes 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.National Hospice and Palliative Care Organization: State Advance Directives Downloads
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.HelpGuide.org: Advance Health Care Directives and Living Wills
Step 2: Discuss Your Wishes with Your Loved Ones
- 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.BaltimoreSun.com: Create your living well, then be sure to discuss it (March 27, 2005]
- You want to get their input, as well as share your thoughts.
- Listen to their opinions.
- 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.Columbus Business First: Discuss living will with loved ones (July 20, 2007)
- 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.
- Obtain your state's living will form from your state health department, local hospital, doctor or the local council on aging.StatePublicHealth.org: Public Directory
- 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.National Hospice and Palliative Care Organization: State Advance Directives Downloads
- 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 5: Communicate
- If you complete the form, but nobody knows about, it won't be used when the time comes.
- Give family members copies of the completed form.
- Give a copy to your doctor and to your lawyer.
- 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.American Bar Association: Living Wills, Health Care Proxies, and Advance Health Care Directives That way, you can ensure that your doctor always has the most up to date information.
