End-of-life medical treatment: It’s not an easy topic to discuss. A living will is an advanced directive that tells medical personnel, as well as family members, what kinds of treatments and life-supporting measures are wanted in the event of a patient’s irreversible terminal condition. It only is used in the event the patient is no longer capable of making and communicating his or her decisions regarding the extent of medical treatment to sustain life.
Reasons to Write a Living Will
1. Providing direction for treatment when unable to communicate: Each of us must face our own mortality, and very often also must make decisions regarding the extent of treatments for loved ones who are terminally ill or in an irreversible coma. When a living will is in place, medical personnel and loved ones have a clear directive; the levels of treatments are made based on the patient’s choices regarding life-sustaining procedures. The living will helps to ease the pain that comes from second-guessing end-of-life choices for the patient.
2. Making a variety of treatment decisions in advance: A living will is not a “do not treat” document. It is a way to list a variety of treatment preferences, based on the patient’s condition, type of illness or accident.
To get started, the Mayo Clinic suggests that we ask ourselves: “What treatments would you want in determining your wishes? Think about your values, such as the importance to you of being independent and self-sufficient, and what would you feel would make your life not worth living. Would you want treatment to extend life in any situation? Would you want treatment only if a cure is possible? Would you want palliative care to ease pain and comfort and discomfort if you were terminally ill?”
While not every scenario can be covered, listing personal preferences for life-sustaining treatments may be included form the following choices:
CPR: Attempt to – or not to – provide cardiopulmonary resuscitation (CPR) when there is no pulse and no breathing.
Medical interventions: providing comfort measures only, limited additional interventions only, or full treatment.
Antibiotics: not providing antibiotics, providing limited antibiotics when there is infection or using antibiotics if life can be controlled.
Artificial nutrition and hydration by tube: providing none if required by tube, use trial period by tube or provide long-term by tube.
Mechanical ventilation: If or how long for treatment if you cannot breath on your own.
Dialysis (artificial kidney function for removing waste blood and managing fluid levels): If or how long to provide treatment.
There are many more choices for treatments, and it is recommended that before completing a living will you discuss the document with your medical provider to fully understand the implications of an advanced directive and the options available.
3. Organ donation: A living will can be very specific about the desire to or not to donate organs, even which organs to donate. In addition, an advanced directive can define the desire to donate your body for scientific study. (Details can be found by contacting the medical facility of your choice.)
4. A living will is a legal document: Signed, witnessed and notarized, a living will is a binding legal document. It cannot be overturned at the whim of a medical professional or well-meaning (or not so well-meaning) family member. It also can be changed as time passes, situations change, medical treatments advance or your personal views and values adjust.
Review and Update Your Living Will
As with any important document, review your living will periodically. Discuss the contents and your directives with your medical provider and family members. Store it where it can be easily retrieved if needed to provide direction to medical providers and family members. For peace of mind, both for you and your family, a living will is one way to assure your wishes for end-of-life treatment are recognized and honored.
May Clinic, Living Wills
Physician Orders for Life-sustaining Treatment, POLST
Advanced Care Directive, Wikipedia