How to Complete a Living Will
What are Advance Care Directives?
Definition
Advance care directives are specific instructions, prepared in advance, that are intended to direct a person's medical care if he or she becomes unable to do so in the future.
Alternative Names
Power of attorney; DNR; Do not resuscitate; Living will
Information
Advance care directives allow patients to provide instructions about their preferences regarding the care they would like to receive if they develop a terminal illness or a life-threatening injury. Advance care directives can also designate someone the patient trusts to make decisions about medical care if the patient becomes unable to make (or communicate) these decisions. This is called designating power of attorney (for health care).
Federal law requires hospitals, nursing homes, and other institutions that receive Medicare or Medicaid funds to provide written information regarding advance care directives to all patients upon admission.
Advance care directives can reduce:
- Personal worry
- Feelings of helplessness and guilt by family members
- Futile, costly, specialized interventions that a patient may not want
- Overall health care costs
- Legal concerns for everyone involved
However, advance care directives cannot predict what situations may arise in the future or what new modes of care may be available for situations considered nearly hopeless today.
EXAMPLES OF ADVANCE DIRECTIVES
Verbal instructions. These are any decisions regarding care that are communicated verbally by an individual to health care providers or family members.
Organ donation. This may be accomplished by completing an organ donation card and carrying it in your wallet. A second card may be placed with important papers (such as a living will, insurance papers, and so on). Most hospitals or other major health care centers have organ donor information available.
Many states offer people who are applying for new or renewed driver's license the opportunity to make a decision regarding organ donation and have it recorded on the driver's license. More information may be obtained by calling 1-800-24-DONOR.
Living will. This is a written, legal document that conveys the wishes of a person in the event of terminal illness. This document can speak for a patient who is unable to communicate. A living will may indicate specific care or treatment the person does or does not want performed under specific circumstances. This may include specific procedures, care, or treatments such as the following:
- CPR (if cardiac or respiratory arrest occurs)
- Artificial nutrition through intravenous or tube feedings
- Prolonged maintenance on a respirator (if unable to breathe adequately alone)
- Blood cultures, spinal fluid evaluations, and other diagnostic tests
- Blood transfusions
State laws vary regarding living wills. Information specific to individual states usually may be obtained from the state bar association, state medical association, state nursing association, and most hospitals or medical centers.
A living will is not to be confused with a last will and testament that distributes assets after a person's death.
Special medical power of attorney. A legal document that allows an individual to appoint someone else (proxy) to make medical or health care decisions, in the event the individual becomes unable to make or communicate such decisions personally.
NOTE: This document provides for power to make medically related decisions only and does not give any individual power to make legal or financial decisions.
DNR (do not resuscitate) order. This states that CPR (cardiopulmonary resuscitation) is not to be performed if your breathing stops or your heart stops beating. The order may be written by the person's doctor after discussing the issue with the person (if possible), the proxy, or family.
RECOMMENDATIONS
- In the event you choose to create a living will or special medical power of attorney, know specific state laws that may apply. Write the document to be consistent with your state's laws.
- If you have a living will or special medical power of attorney, provide copies for your family members and health care providers. Carry a copy with you in a wallet, glove compartment of a car, or similar location. If you have a planned admission to a hospital, take copies for the hospital to include in your medical chart and tell all medical personnel involved with your case about the documents.
- Consider the possibilities of the future, and plan ahead. Studies have shown that although the majority of people believe having some form of advance directive is a good idea, most people have not actually developed advance directives for themselves. Many people state that they want their families to make health care decisions. However, less than half of these people have ever discussed the issue and their specific desires with family members.
- These decisions can be changed at any time. However, if a living will is changed, everyone involved -- including family or proxies and all healthcare providers -- must be informed and new copies of instructions made and distributed.
SUMMARY
The process of creating advance care directives may be difficult. It requires you to think about your priorities regarding quality of life and your death. Treatment options, and their possible influence on your quality of life, need to be fully understood and considered. Know the potential implications of choosing or refusing specific forms of care.
Discuss your wishes regarding advance care directives with your health care providers, family members, and friends. Review your wishes from time to time to remind everyone.
Sample living will
A person may write and use a living will without writing a health care power of attorney or may attach a living will to the person's health care power of attorney. If a person has a health care power of attorney, the agent must make health care decisions that are consistent with the person's known desires and that are medically reasonable and appropriate. A person can, but is not required to, state the person's desires in a living will. The following form is offered as a sample only and does not prevent a person from using other language or another form:
LIVING WILL DECLARATION OF
_______________
To my family, doctors, hospitals, surgeons, medical care providers, and all others concerned with my care:
I, ______________________________, being of sound mind and rational thought, willfully and voluntarily make this declaration to be followed if I become incompetent or incapacitated to the extent that I am unable to communicate my wishes, desires and preferences on my own.
This declaration reflects my firm, informed, and settled commitment to refuse life-sustaining medical care and treatment under the circumstances that are indicated below.
This declaration and the following directions are an expression of my legal right to refuse medical care and treatment. I expect and trust the above-mentioned parties to regard themselves as legally and morally bound to act in accordance with my wishes, desires, and preferences. The above-mentioned parties should therefore be free from any legal liabilities for having followed this declaration and the directions that it contains.
DIRECTIONS
1. I direct my attending physician or primary care physician to withhold or withdraw life-sustaining medical care and treatment that is serving only to prolong the process of my dying if I should be in an incurable or irreversible mental or physical condition with no reasonable medical expectation of recovery.
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2. I direct that treatment be limited to measures which are designed to keep me comfortable and to relieve pain, including any pain which might occur from the withholding or withdrawing of life-sustaining medical care or treatment.
3. I direct that if I am in the condition described in item 1, above, it be remembered that I specifically do not want the following forms of medical care and treatment:
A. _____________________________________
B. _____________________________________
C. _____________________________________
D. _____________________________________
E. _____________________________________
F. _____________________________________
G. _____________________________________
H. _____________________________________
I. _____________________________________
J. _____________________________________
K. _____________________________________
4. I direct that if I am in the condition described in item 1, above, it be remembered that I specifically do want the following forms of medical care and treatment:
A. _____________________________________
B. _____________________________________
C. _____________________________________
D. _____________________________________
E. _____________________________________
F. _____________________________________
G. _____________________________________
H. _____________________________________
I. _____________________________________
J. _____________________________________
K. _____________________________________
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5. I direct that if I am in the condition described in item 1, above, and if I also have the condition or conditions of ____________________, that I receive the following medical care and treatment:
This Living Will Declaration expresses my firm wishes, desires, and preferences and the fact that I may have executed a form specified by the law of the State of _____________, may not be used a limiting or contradicting this Living Will Declaration, which is an expression of both my common law and constitutional rights.
I make this Living Will Declaration the _______ day of __________, 20____.
_______________________________________________
Declarant's Signature
________________________________________________
________________________________________________
________________________________________________
Declarant's Address
WITNESS STATEMENTS
I declare that the person who signed or acknowledged this document is personally known to me, that he/she signed or acknowledged this Living Will Declaration in my presence, and that he/she appears to be of sound mind and under no duress, fraud, or undue influence.
________________________________________________
Witnesses' Signature
________________________________________________
Witnesses' Printed Name
________________________________________________
________________________________________________
Witnesses' Address
I declare that the person who signed or acknowledged this document is personally known to me, that he/she signed or acknowledged this Living Will Declaration in my presence, and that he/she appears to be of sound mind and under no duress, fraud, or undue influence.
________________________________________________
Witnesses' Signature
________________________________________________
Witnesses' Printed Name
________________________________________________
________________________________________________
________________________________________________
Witnesses' Address
NOTARIZATION
STATE OF _______________________, COUNTY OF ___________________
Subscribed and sworn to before me his ________ day of ________, 20_____.
_______________________________
Signature of Notary Public
My commission expires: ________________________________
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NOTES ABOUT LIVING WILL DECLARATION FORM:
- Paragraphs one and two can be tailored to suit your own desires. For example, you could redraft paragraph one to state that you would like to have life-sustaining treatments for "x" number of days or weeks and then if no progress is made and there is no reasonable hope of recovery, you would like to have the life-sustaining treatments withdrawn. As for paragraph two, if you do not wish to receive pain medications you can state those wishes there.
- Paragraph three of the Declaration allows you to list all specific types of treatment you wish not to receive. If you do not have strong feelings about any particular types of treatment, you do not need to include this paragraph in your own living will. However, if you do have strong preferences, this is the place to list them.
Examples: Antibiotics, artificial feedings, hydration and fluids, blood transfusions, cardiac resuscitation, dialysis, intravenous lines, invasive tests, respiratory therapy, mechanical respiratory assistance, and surgery.
Note: For many people, taking away food and water from a dying person seems especially cruel because they may feel as though the person is starving or dehydrating to death. However, you have a right to make your specific wishes known on the subject. It is advisable, however, to be particularly clear on those issues so that there is no room for your loved ones to debate. In addition, they will likely feel less burdened by guilt if they are certain they are following your specific wishes not to be artificially fed or hydrated.
- Paragraph four is the converse of paragraph three and allows you to clearly state what care and treatment you would like to receive. In addition, if you have specific instructions for other types of care, you may wish to include them in this paragraph.
Examples: At-home or hospice care as the end approaches, feelings about religious practices or customs at a terminal stage (for instance, if you wish for a certain clergy member to be called and be present).
- Paragraph six allows you to essentially "change" your wishes should you also have another medical condition when you become incapacitated or incompetent.
Example: For women of child-bearing age, the desire to forego life-sustaining treatment may be compromised if they are pregnant. In those situations, they may wish to be kept alive, if possible, until the baby can be safely delivered at which point, if there has been no recovery or reasonable progress, they may wish to then have their life-sustaining treatments withdrawn.
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