LIVING WILL DIRECTIVE FOR MEDICAL DECISIONS & THE IMPORTANCE OF HAVING ONE
March 1, 2021
A Living Will, more commonly known as a “Health Care Directive”, is a set of written legal instructions regarding your preferences for medical care only when you are unable to make these decisions for yourself. It spells out word for word the medical treatments that you would not want to be used to keep you alive, as well as other medical decisions and preferences including pain management and organ donation. It is a guide for doctors and caregivers if you are
In a coma;
In the late stages of dementia; or
Near the end of life.
It is important for all adults to prepare living will directives because unexpected end-of-life situations can happen at any age.
Planning ahead is key so that you can get the medical care you want and relieve caregivers of the stress of making these decisions at a time of grief or during a medical crisis. Planning also reduces any disagreement or confusion about the choices you want to make and so that your caretakers and family can quickly and easily make them on your behalf.
In making these important decisions for your Living Will it is necessary to consider the importance of your independence and being self-sufficient in daily life. Now what circumstances would it take to make you feel like your life is not worth living is a very personal and specific question. Questions that will arise in creating your living will include for example:
Would you want treatment if a cure is possible?
Would you want treatment to extent your life in any situations? All situations?
All possible end-of-life care and decisions should be discussed in your living will. You should talk to your doctor if you have any questions about the following medical decisions. Examples provided from Mayo Clinic include:
Cardiopulmonary resuscitation (CPR) restarts the heart when it has stopped beating. Determine if and when you would want to be resuscitated by CPR or by a device that delivers an electric shock to stimulate the heart.
Mechanical ventilation takes over your breathing if you're unable to breathe on your own. Consider if, when and for how long you would want to be placed on a mechanical ventilator.
Tube feeding supplies the body with nutrients and fluids intravenously or via a tube in the stomach. Decide if, when and for how long you would want to be fed in this manner.
Dialysis removes waste from your blood and manages fluid levels if your kidneys no longer function. Determine if, when and for how long you would want to receive this treatment.
Antibiotics or antiviral medications can be used to treat many infections. If you were near the end of life, would you want infections to be treated aggressively or would you rather let infections run their course?
Comfort care (palliative care) includes any number of interventions that may be used to keep you comfortable and manage pain while abiding by your other treatment wishes. This may include being allowed to die at home, getting pain medications, being fed ice chips to soothe mouth dryness, and avoiding invasive tests or treatments.
Organ and tissue donations for transplantation can be specified in your living will. If your organs are removed for donation, you will be kept on life-sustaining treatment temporarily until the procedure is complete. To help your health care agent avoid any confusion, you may want to state in your living will that you understand the need for this temporary intervention.
Donating your body for scientific study also can be specified. Contact a local medical school, university or donation program for information on how to register for a planned donation for research.
In addition to a Living Will, in some cases a Medical Power of Attorney can be appropriate. A medical or health care power of attorney is advance directive which you choose to give legal authority to another person you want to make medical decisions for you. This removes the risk of someone you did not approve of being automatically appointed making these health care decisions on your behalf. This directive could also be called a durable power of attorney for health care or a health care proxy in some states depending where you live. The person that you choose to make decisions on your behalf could be called the following:
Health care agent;
Health care proxy;
Health care surrogate;
Health care representative;
Health care attorney-in-fact; or
It is important that the person you chose to be your health care agent/attorney/proxy is someone you trust because not all life situations can be anticipated for. Some situations will require a judgment made about how you wish to decide and handle said situation. This person that you choose can be a spouse, family member, or a member of a faith community. If that person is unable to fulfil that role, you can also have a person of back up. It is highly suggested to have the person appointed to meet the following criteria:
Well trusted to be your advocate if disagreements arise about your care;
Well trusted to make decisions that cohere to your wishes and values;
Willing and able to discuss medical care and end-of-life issues with you;
NOT your doctor or a part of your medical care team; and
Meets your state’s requirements for health care agent/attorney/advocate.
Commonly, if you are married, your spouse will be the person that makes your medical decisions if you are incapable of doing so. Although you do not have to be married for a medical directive, your partner can be appointed. Domestic partners are not typically allowed to make emergency medical decisions for each other without this living directive. If not, you are not legally married it is important to give your partner the authority before something happens.
Say you have been living with your partner for years in the same house, even maybe have children with them, you must have a living will directive in order to appoint them to make decisions. If this person is not your spouse, they will not have authority in decision making without the living will directive. The directive will consist of a health care declaration and a durable power of attorney. The type of rights that your boyfriend or girlfriend will include are:
Providing medical decisions that aren’t covered in your healthcare declaration;
Hiring and firing doctors and medical workers for treatments;
Access to medical records; and
So stressing the importance of having a living will directive planned for unmarried partners should not go unnoticed, or be left till it’s down to crucial time.