Senior legal guide: introduction to living wills

This article explains the basics of living wills and provides information on how to get a living will form.

The woman in ICU lies in a permanent coma, the victim of a massive stroke. Outside in the hall, her family debates fiercely.

"Mom would never want to just exist like that with tubes coming out of everywhere," her younger son cries. "She'd hate us if we kept her alive on machines."

"I'm not so sure," says the older son. "Mom always told me she wanted to live to see her hundredth birthday."

"But she didn't say she wanted to live like this!"

This all too common, heartbreaking scenario could have been avoided if the woman had completed a living will that made her wishes clear to her family and doctors.

This article answers frequently asked questions about living wills and explains how to execute a living will.

QUESTION: What is a living will?

ANSWER: A living will is a document that tells people what kind of care you would want in the event that you have a life-limiting illness or injury and cannot communicate about your healthcare wishes.

QUESTION: Does having a living will mean I won't receive any medical care?

ANSWER: Not at all. The living will offers you the opportunity to request limited care in clearly specified circumstances. For instance, suppose you are in a car accident. The paramedics at the scene don't know if you will live or die, so they proceed with aggressive treatment to stabilize your condition. After a few days at the hospital, you are sill unconscious, and it becomes clear that you have suffered massive brain damage. The doctors and your family would then refer to your living will for guidance about your treatment preferences. If you stated in the living will, for instance, that you do not want to be kept alive by breathing machines if there is no chance of recovery, your ventilator would be removed at that time.

QUESTION: What if I WANT aggressive treatment in all cases?

ANSWER: You can state that on your living will. You can also request certain treatments while refusing others. For instance, a client of mine with early dementia wrote on his living will that he did not want a feeding tube or ventilator in the last days of his life, but would accept antibiotics for infections and fluid through IVs.

QUESTION: Who should have a living will?

ANSWER: Every adult, no matter how healthy they are. It is unpleasant to think about your own mortality, but every adult is vulnerable to accidents, injuries, sudden serious illnesses, etc. It's a gift to your loved ones to let them know exactly what you want, so that they don't have to second guess your wishes and struggle with guilt that they "didn't do the right thing."

QUESTION: When does a living will go into effect?

ANSWER: When you are incapacitated and have a life-limiting condition. For instance, say an elderly, frail woman with dementia develops pneumonia. She hasn't spoken in years and doesn't seem to understand what is happening to her. We check her living will, and find that she does not want antibiotics for infections if they cannot cure her underlying condition. We keep her comfortable, and she dies a few days later.

Now suppose you bump your head and black out for ten minutes. Your living will won't go into effect because it is assumed you will make a complete recovery. Nor would your living will go into effect if your condition is life-limiting but you can still communicate. For instance, a cancer patient I worked with had written in his living will that he wanted to be kept alive on a breathing machine as long as possible. However, when the day arrived when he could no longer breathe effectively on his own, he was still able to communicate with us and wrote on a chalkboard, "DON'T put me on a vent." His living will did not go into effect because he was still able to communicate his wishes.

QUESTION: How can I execute a living will?

ANSWER: The proper format for a living will varies from state to state. An attorney can help you prepare one, although this is an expensive option. You can also get a living will document from your local hospital. Just ask for the social services department. This is an especially good option, because if you have difficulty understanding the questions or the meanings of the different options, a social worker can assist you. There are also living will forms appropriate to each state available on the internet. Skip the sites that ask you to pay for the forms, because other sites offer them at no cost. You do not have to file a living will with the court.

QUESTION: What if I change my mind about what is in my living will?

ANSWER: That often happens as people get more information and their values and goals change. You can void your living will simply by saying you no longer want it to be in effect. A better way, though, is to write VOID across your copy and to ask any family members, doctors, hospitals, etc. who have the old living will to do the same.

QUESTION: I've completed a living will. Now what?

ANSWER: Keep a copy of your living will on you at all times. Give one to any doctor you regularly see and any hospital where you are regularly treated. It's also important to share your living will with family and friends, and to discuss your wishes with them. That way, if the worst happens, arguing and agonizing over decisions will be limited--you'll have already made the tough choices for them.

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