Living Wills – An Overview
Sudden trauma or serious illness often brings family members together for the first time in years. Heart-wrenching decisions need to be made. In some families, there may be a natural decision-maker. In others, too many options, too many conflicting values, too much friction, and too little practice in making joint decisions create fierce disagreements that may hurt both the family and the patient.
Do you trust your family members to make good healthcare decisions on your behalf? Does your family know the quality of life with which you are willing to live? Have you made known to them your idea of a "good death," or what you consider a "death with dignity?"
Most people envision a peaceful death at home, surrounded by loved ones. But, 80% of us will die in long-term care facilities, or hospitals. In these settings, many modern healthcare treatment options are readily available. Unfortunately, when a patient can no longer weigh these options themselves, difficult healthcare decisions can fall to distraught family members.
Statistics show that 60-70% of all seriously ill patients reach a point where they are unable to speak for themselves. These patients can still have a say in their medical care. Living wills provide written instructions to guide loved ones and doctors as they make difficult healthcare and end-of-life decisions.
Advance Care Directives
Living wills may be referred to as advance care directives, or healthcare directives. The purpose of these documents is to:
- Outline a person’s goals and wishes regarding life-sustaining medical care;
- Designate a healthcare decision-maker who will speak on the patient’s behalf when they are no longer able to participate in their healthcare treatment decisions;
- Provide instruction regarding treatments that may be offered to prolong life.
Withholding or Withdrawing Treatment
Medical treatment and terminology may be confusing. It is important to understand the ramifications of your decisions. Have a discussion with a physician with whom you have an established rapport. This conversation is imperative in order to write an effective living will. You must appreciate the difference between life saving, and life sustaining treatments in order to leave appropriate instructions for your decision-maker. Some of the therapies that must be considered include:
- CPR – Cardio Pulmonary Resuscitation;
- Mechanical Ventilation – requires "intubation" (placement of a breathing tube into the trachea for attachment to a breathing machine);
- Nutrition and Hydration – tube feedings or IV nutrition;
- Kidney Dialysis – prolongs life when kidneys fail;
- Antibiotics or Pain Medication Therapy.
Decisions must be made when to receive treatment, and for how long. Are there treatments an individual considers unethical? Does the treatment threaten personal dignity? Will treatment cause unjustified pain? It is never too soon to draft a living will that expresses your wishes regarding these highly personal decisions.
When working with an attorney to complete a living will, it is very important that the process include the patient, patient’s family, and designated decision-maker. A nurse, social worker or the patient’s physician may be included in some discussions. The goal is to ensure the decision-maker understands and respects the patient’s values in drafting the directive, not just the specific instructions regarding medical treatment. This process will ensure the understanding and effectiveness of the decision-maker when difficult medical decisions must be made.
Components of a Living Will
The old form of a living will consisted primarily of a generalized statement such as instructions to withhold or withdraw medical intervention if the patient suffered from a terminal condition, or was no longer able to make their own healthcare decisions. Today, the living will includes:
- Specific health care directives;
- Assignment of power of attorney
- Assignment of a healthcare proxy (substitute decision-maker).
Thoughtful discussion and written directives are the best tools available to guide families as they struggle to make healthcare decisions for a loved one. An attorney experienced in writing living wills can answer your questions regarding the living will requirements for your state.
DISCLAIMER: This site and any information contained herein is intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.
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Living Wills – An Overview
Legal and Ethical Issues Surrounding End of Life Decisions
Purpose of a Living Will / Advance Care Directives
History of Living Wills
Living Wills Resource Links