End-of-life medical treatment is not an easy topic to discuss. Whether it is for yourself or a loved one, the subject can be emotionally charged. Many people choose to write a living will as an advance directive which provides their wishes in the event they are in a medically terminal situation and cannot express their treatment choices. For many, this is a good and wise decision; however, the living will is not always the right or only answer. Before writing a living will, consider these points and options.
Reasons to Not Write a Living Will
Interpretation of you wishes is in the hands of your medical team. For example, if the directive is too vague, than translation may be difficult. A doctor honoring the Hippocratic Oath, that states his decisions should be based on the ability to: “… benefit the patient according to (the physician’s) ability and judgment…” may find it difficult to reconcile with your wishes to not provide “heroic measures.”
A living will is a binding legal document. Often a living will, as with other documents, is written, secured in a safe place, and never reviewed. If the living will does not reflect your current wishes for treatment but you are no longer able to express those changes, then the living can only be honored as originally written.
You don’t get to decide when to enact a living will. It is only when a person is deemed terminally ill and cannot make clear decisions that a living will is put in place. It is the medical team’s decision when the end-of life stage has been met, and before that they may be taking steps that go against your values and choices for medical treatments.
Living wills can be expensive. A living will should be prepared with the advice of a medical provider and in some states, must be written or notarized by an attorney. The initial process can be more expensive than a regular will, and may require several changes over the years.
Living wills are not always available when they are needed. Accidents and illnesses do not always happen conveniently close and accessible to the location of the living will. Without the tangible living will in the possession of the medical team, they must follow their own guidelines, which may not be in accordance with your wishes. Also, if the living will has been locked away in a safe location and family members or friends do not have access to the location, then it is as if there were no living will.
Combine other advanced directives to make your living will more binding. Advanced directives may include the living will, plus a medical power of attorney (POA). Or you may choose to have just a medical POA. This is a legal document that designates a trusted individual as your health care agent or proxy. He or she is authorized to make medical decisions in the event you are unable to. In addition, you may want to add another directive: A do not resuscitate (DNR) order, which requests that there be no attempt to have cardiopulmonary resuscitation (CPR) if your heart stops or you stop breathing. The DNR can be placed on the medical chart. By combining all the advanced directives, it is far more likely that the original wishes will be closely followed.
Complete a POLST document. According to the POLST website, “The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm program is designed to improve the quality of care people receive at the end of life. It is based on effective communication of patient wishes, documentation of medical orders on a brightly colored form and a promise by health care professionals to honor these wishes.”
The POLST form summarizes your wishes regarding life-sustaining treatment and is intended for any individual with a terminal illness. The benefits are that it is portable from one care setting to another and it translates wishes of an individual into actual physician orders. The attending physician, nurse practitioner or PA-C should complete the document with the patient. He or she must also sign the form and assume full responsibility for its accuracy. The form is then placed as the first document in the clinical record and recognized as a set of physician orders.
Of course this assumes that you are able of understand and complete these forms. If that is not the case, this is where it is critical to have other advance directives available if you wish to have special end-of-life directives made known to the medical team.
Register your advance directives on-line. Many states now offer a registry to preserve final wishes by recording a living will and/or durable power of attorney for health care, POLST form and mental health advance directives. This is one way to be sure that your treatment choices are up-to-date and accurate. To determine if your state offers this registration, use your search engine to go to your state’s department of health website.
Making Your Medical Treatment Decisions
Writing a living will is not always the answer. You may want to write one and augment it with other advance directives, give all the decision making to a designated individual through a medical power of attorney, depend on a POLST form, or do nothing at all. The choice is clearly up to each individual. The decision really comes down to this: When it comes to end-of-life medical decisions, what do you want for yourself and those who love and care for you?
The Physician Orders for Life-Sustaining Treatment (POLST): Website
Hippocratic Oath: www.medterms.com/script/main/art.asp
Washington State Patient Resources: website