Living Wills

What Is a Living Will?

An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. In the U.S. it has a legal status in itself, whereas in some countries it is legally persuasive without being a legal document.

Living Will vs. Will

A will or testament is a legal document that expresses a person's (testator) wishes as to how their property (estate) is to be distributed after their death and as to which person (executor) is to manage the property until its final distribution. For the distribution (devolution) of property not determined by a will, see inheritance and intestacy.

Though it has at times been thought that a "will" historically applied only to real property while "testament" applied only to personal property (thus giving rise to the popular title of the document as "last will and testament"), the historical records show that the terms have been used interchangeably. Thus, the word "will" validly applies to both personal and real property. A will may also create a testamentary trust that is effective only after the death of the testator.

Living Will vs. Advance Directives

While a living will is just one document, advance directives can be made up of several documents. Some of the documents that could be included are: the living will itself, a DNR (Do Not Resuscitate) order, directions about organ and tissue donation, specific instructions about a diagnosed illness, and medical power of attorney.

But just to make things confusing, a living will isn’t always called the same thing from state to state, and the term is sometimes used interchangeably with advance directive. So, you’ll want to make sure you know what your state calls it.

Whether your state’s term is one we already mentioned or a “directive to physicians,” “advance health care directive,” or even a “declaration regarding life-prolonging procedures,” they all have the same type of job—to let doctors know your wishes about end-of-life medical procedures if you can’t speak for yourself.

Living Will vs. Medical Power of Attorney

A medical or health care power of attorney is a type of advance directive in which you name a person to make decisions for you when you are unable to do so. In some states this directive may also be called a durable power of attorney for health care or a health care proxy.

Depending on where you live, the person you choose to make decisions on your behalf may be called one of the following:

• Health care agent

• Health care proxy

• Health care surrogate

• Health care representative

• Health care attorney-in-fact

• Patient advocate

Choosing a person to act as your health care agent is important. Even if you have other legal documents regarding your care, not all situations can be anticipated and some situations will require someone to make a judgment about your likely care wishes. You should choose a person who meets the following criteria:

• Meets your state's requirements for a health care agent

• Is not your doctor or a part of your medical care team

• Is willing and able to discuss medical care and end-of-life issues with you

• Can be trusted to make decisions that adhere to your wishes and values

• Can be trusted to be your advocate if there are disagreements about your care

What Do I Include in My Living Will?

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?

• Cardiopulmonary resuscitation (CPR) restarts the heart when it has stopped beating. 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.

• Mechanical ventilation takes over your breathing if you're unable to breathe on your own. Consider if, when and for how long you would want to be placed on a mechanical ventilator.

• Tube feeding supplies the body with nutrients and fluids intravenously or via a tube in the stomach. Decide if, when and for how long you would want to be fed in this manner.

• Dialysis removes waste from your blood and manages fluid levels if your kidneys no longer function. Determine if, when and for how long you would want to receive this treatment.

• Antibiotics or antiviral medications can be used to treat many infections. If you were near the end of life, would you want infections to be treated aggressively or would you rather let infections run their course?

• Comfort care (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.

• Organ and tissue 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 health care agent avoid any confusion, you may want to state in your living will that you understand the need for this temporary intervention.

• Donating your body for scientific study also can be specified. Contact a local medical school, university or donation program for information on how to register for a planned donation for research.

When Does a Living Will Go Into Effect?

A living will only works while these two things are true: You must be unable to communicate but still be alive. For instance, if you were confused or in a coma because of a head injury, your doctors would want to look at your living will for direction. But the moment you’re able to communicate on your own, your living will becomes unneeded and has no authority.

Each state handles living wills in its own way. You’ll want to make sure your living will is prepared according to your state’s specific guidelines.

Do You Need a Living Will?

To keep things simple, having a medical power of attorney instead of a living will might make more sense for you. A medical power of attorney can decide what’s in your best interests based on what you would have wanted and still be flexible (unlike a piece of outdated paper). That way, you have the peace of mind knowing—in what could be an unpredictable situation—there is someone you trust making those medical calls on your behalf.

You can set up your medical power of attorney while you’re creating your last will and testament in just a few minutes—leaving you to get back to enjoying your best life with the people you love.