What is a living will?
A living will is a term used to describe a “legal” document you can create which summarizes your care preferences if you are incapable of making medical decisions. This can be as a result of a terminal condition or a present vegetative state. Some individuals may be suffering from an end-stage condition that also makes them incapable of deciding the care they need.
A living will can indicate a person to carry out your medical wishes. This provides an opportunity for individuals to state what type of life–prolonging procedures they would want (or not want), including circumstances under which they would choose certain procedures or have them withheld or withdrawn. An example would be staying on life support after an individual has been determined to be “brain dead” or clinically they will never regain consciousness or start breathing on their own without life supporting machines.
It is also providing an opportunity for conversations about other issues which may be important to you; for example, how an individual’s religious preference will play in end-of-life decisions. One of the most common examples I have encountered are with individuals who identify as Jehovah’s Witnesses. They believe that it is against God’s will to receive blood and, therefore, they refuse blood transfusions, even if it is their own blood.
A lawyer is recommended but is not necessary to complete a living will, but it is advised that it should be signed, dated, and witnessed by 2 people. At least one of the witnesses must be someone who is not your spouse or relative. You should discuss your wishes with your family and your physician. It is important to discuss your decisions with your doctor because a living will become a part of your permanent medical record.
What is a DNR also known as DO NOT RESUSCITATE?
This order identifies a person who does not wish to be resuscitated from respiratory or cardiac arrest through life saving measures such as CPR or intubation.
What happens if I do not have an advanced directive?
If you do not have a living will or have not designated a healthcare surrogate (individual who makes decisions for a patient who is unable to do so themselves), and a physician has determined that you lack the capacity to make healthcare decisions, the law requires that a healthcare proxy is appointed on your behalf. A healthcare proxy follows an order of priority which includes legal guardian, spouse, adult child, parent, adult siblings, adult relatives and a close friend. Treatment decisions about your health can be difficult when there is no surrogate of healthcare or no proxy appointed. A living will gives you and your loved ones peace of mind that your preferences for end-of-life care are done.
What decisions can a healthcare surrogate make for me?
There are certain decisions that your surrogate can make based on prior conversations of your expectations. Some of these authorized decisions include convulsive therapy, voluntary admission to mental health facilities, abortion, experimental treatments and sterilization. You are ultimately in control of what decision you allow a healthcare proxy or your healthcare surrogate to make as it relates to your health, including the ability to consent to withholding or withdrawal of life–prolonging procedures.
What should I do once I have created a living will?
Once you have a living will, you should talk with your family, friends or attorney and provide them with a copy as well as inform your physician so that it can be added to your medical records.
Copies of your living will should be easily accessible to those who need them. Some individuals keep a small card in their wallet that identifies the presence of a living will or that they have an advanced directive. The card can identify the location of the document as well as the name and telephone number of the healthcare proxy. Your healthcare proxy should always have copies of your advance directive.