When you create a living will, you take responsibility for the manner in which you choose to die. It comes into effect when you are no longer able to voice your own wishes or make your own decisions. Everyone has a legal right to sign a living will (as long as you are older than 18). It means that death can occur naturally by withdrawing or withholding artificial life-support. Medical personnel have a duty to obey your wishes if you have signed a living will.
What is a Living Will?
A living will is a legal document that gives instructions for your end-of-life care and medical treatment. It is not like a traditional will – it comes into effect when you are still alive.
You living will comes into effect when the following conditions are met:
- Terminal illness certified by a physician
- Permanent unconsciousness or coma
- Later stages of dementia
- Near the end of life
Other names can be used for a living will such as an advanced health care directive. Executing the provisions of a living will should not be confused with ‘active euthanasia’ or ‘mercy killing’ which is illegal in many countries.
There are various end-of-life issues that are dealt with in a living will.
Treatments that prolong life
Living wills will usually state whether you want to receive treatments to prolong your life or not. These procedures may include:
- CPR (cadiopulmonary resuscitation)
- blood transfusions
- using a respirator
- giving drugs
Food and Water
Medical personnel give patients nutrients and fluids intravenously when they are no longer able to eat or drink. A patient who is permanently unconscious can live indefinitely being fed and hydrated artificially. If food and water are no longer administered, death due to dehydration occurs in a relatively short time. It is hard for children to accept that a parent doesn’t want food and water – this decision is probably the most difficult one to make.
Palliative Care (Pain Relief)
Palliative care helps a patient to remain as free of pain and as comfortable as possible until life ends naturally. Feelings and preferences about palliative care can be included in a living will. This type of care does not prolong life but helps a patient to face the dying process with dignity.
Drawing up a Living Will
Prior to drawing it up
Before drawing up a living will, it’s a good idea to speak to a doctor about the choices you will have to make. These are not decisions that can be taken lightly and its important to understand the various medical terms. For example, there is a difference between life support and resuscitation. Life support means using equipment like a feeding tube or ventilator to keep you alive. Resuscitation occurs when your heart has stopped beating to make it start beating again.
Speaking to your family is also important. It can put an incredible burden on your family to make a decision to “pull the plug,” or decide not to continue with life-prolonging treatment. Drawing up a living will takes away this burden.
- Full legal name, street address and telephone number.
- Date on which your will takes effect. A statement like “If and when the writer cannot make health care decisions” is usually used and this is determined by a doctor. You can specify if you would like two doctors to determine your incapacity.
- Full name, address and telephone number of a health agent who will carry out your wishes. You need to make sure that who you consider appointing is not uncomfortable with your choices. Typically, people decide on a spouse or an adult child as their agent.
- Instructions on issues such as blood transfusions, resuscitation, surgery etc.
- You can specify if you want to donate your organs at the time of your death. If you are already an organ donor, you do not have to specify this.
- Witness information – a witness has to verify the will and should have no vested interest in the declining health of the person. The full legal name and address of the witness should appear.
- Signatures – both the person and the witness.
To fill in the living will form, you will have to answer questions such as the one that follows, choosing which option you prefer.
If my doctors certify that my death from a terminal condition is imminent, even if life-sustaining procedures are used:
- Keep me comfortable and allow natural death to occur. I do not want medical interventions used to try and extend my life. I do not want to receive nutrition and fluids by tube or other medical means.
- Keep me comfortable and allow natural death to occur. I do not want medical interventions used to try and extend my life. However, I do want to receive nutrition and fluids by tube or other medical means.
- Try to extend my life for as long as possible, using all available interventions that in reasonable medical judgement would prevent or delay my death. If I am unable to take enough nourishment by mouth, I want to receive nutrition and fluids by tube or other medical means.
Living will forms are available from various different sources such as attorneys, living will societies, senior centres and hospitals. It is possible to download free templates online but internet forms may be outdated (the laws are changing all the time) and you have to make sure they are applicable to the laws of your state or country. Could you just write out your wishes? Theoretically, this is possible, but it’s better to err on the side of caution and using some kind of template helps you to cover all the areas that need to be addressed. A Five Wishes living will created by Aging with Dignity, a nonprofit organization, is popular as it is written in everyday language and it’s inexpensive. Once you register online, you can create, access, change and print your living will at a minimal cost.
What to do with your signed living will?
You should give a copy of your signed living will to your family members, your physician and your hospital or care facility. It will always be difficult to bring up this subject with your loved ones but they need to know your wishes. You can’t just file it and forget about it. You can change or cancel your living will at any time and for any reason. If you do decide to cancel, you should immediately notify anyone who has a copy.
Deciding what kind of care you want is not easy. You are able to state your own preferences but you will also have to carefully consider how your choices will affect your loved ones. Making a living will can often help to reduce the stress of an already stressful situation.