Living Wills: Everybody Should Have One
A living will states your wishes regarding life support in the event that you cannot communicate your end-of-life wishes. A living will comes into effect only if you are in a persistent vegetative state or irreversible coma and can no longer make and communicate your own wishes, thus sparing your family the anguish of making life-support decisions without your input. The document ensures that your doctor understands and treats you accordingly.
Any person over age 18 may create one. Common reasons to do so include:
- A desire to state your wishes so that it is more likely they will be carried out.
- Designation of a specific person to make healthcare decisions for you.
- Declining health.
- The possibility of surgery or hospitalization.
- Diagnosis of a terminal condition with no hope of recovery.
A medical power of attorney (or healthcare proxy) allows you to appoint a person you trust as your healthcare agent (or surrogate decision-maker) who is authorized to make medical decisions on your behalf.
Besides focusing on specific treatments and medical procedures, living wills also can include your values, personal goals and health outcomes. Your designated agent will be able to make care decisions regarding what kind of life-support treatment you want; your instructions on pain management, personal grooming and bathing; what sort of religious, spiritual and emotional support you desire; and your detailed funeral or memorial plans.
It's best to make living wills very specific. If too vague, they may not provide sufficient direction and could serve only to create confusion and conflict among medical personnel, your healthcare agent and your loved ones. Thoughtful reflection on your wishes and values supported by personal communication between you and your healthcare agent will help you create a useful document before a medical crisis occurs.
Before your living will can guide medical decision-making, two physicians must certify:
- You are unable to make medical decisions.
- Your condition, as specified in the state's living will law, can be described as terminal illness or permanent unconsciousness.
Before a medical power of attorney goes into effect, a physician must conclude that you're unable to make your own medical decisions. In addition:
- If a person regains the ability to make decisions, the agent cannot continue to act on the person's behalf.
- Many states have additional requirements that apply only to decisions about life-sustaining medical treatments. For example, before your agent can refuse a life-sustaining treatment on your behalf, a second physician may have to confirm your doctor's assessment that you are incapable of making treatment decisions.
What Else Do I Need to Know?
Living wills, also called advance directives, are legally valid throughout the United States. However, the laws governing advance directives vary from state to state, so it is important that yours complies with your state's law.
Emergency medical technicians cannot honor living wills or medical powers of attorney. Once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital, both from accident sites and from a home or other facility. After a physician fully evaluates the person's condition and determines the underlying conditions, advance directives can be implemented.
One state's advance directive may not work in another state. Some states honor living wills from another state, others will honor out-of-state advance directives as long as they are similar to the state's own law, and some states don't honor them. If you spend a significant amount of time in more than one state, complete a living will in each state.
But the good news is that a living will doesn't expire, remaining in effect until you change it. If you complete a new advance directive, it invalidates the previous one.
You should review your living will periodically to ensure it still reflects your wishes regarding the types of life-sustaining treatments available and the types of treatment you'd want or not want. Be sure to share your end-of-life wishes and preferences with your loved ones so there's no confusion during the difficult time when a living will may come into play.
In most states, you can include such special requests as wishes about organ donation. Make your physician and loved ones aware of your specific requests so appropriate referrals and arrangements can be made. Make several photocopies of the completed documents and tell others where you put them. Do not keep your advance directives in a safe deposit box — other people may need access to them. Give photocopies to your healthcare agent and alternate agent.
Be sure your doctors and anyone who might be involved in your healthcare decision-making as well as your family, clergy and friends have copies. Your local hospital probably will file a copy in case you are admitted in the future. You want your loved ones, doctors and hospital to understand how you feel about medical treatment at the end of life.
Give us a call if you have any questions or would like to explore setting up a living will yourself.