Living Wills / Advanced Health Care Directives

Living wills and advance health care directives dictate an individual’s preferences for end-of-life care. They are written instructions regarding the drafter’s wishes for medical care once he or she can no longer make those decisions. These documents guide doctors should the drafter become terminally ill, get severely injured, enter a coma or permanent vegetative state, or develop serious dementia. They also help doctors when drafters are near the ends of their lives. These documents come into play when there is no hope of the drafter’s recovery.

Planning ahead with living wills and health care directives relieves loved ones and caregivers from having to make stressful decisions in moments of tragedy and grief. These documents help reduce confusion and disagreement about the choices to be made on the drafter’s behalf. Since unexpected and tragic situations can occur at any age, it is important for all adults to prepare these documents.

A medical power of attorney is a type of advanced directive that involves naming a person to make decisions for the drafter when he or she can no longer do so. The agent may be a spouse, friend, or other family member. It is wise to choose alternate agents in case the first choice agent is for some reason unable to fulfill his or her role. Choosing a health care agent is important. Not all situations can be anticipated, and some require someone to make a snap decision. It is important to choose someone separate from the drafter’s doctor and medical care team and someone who can be trusted.

A living will is a written document that dictates the types of medical treatment that the drafter wants, or does not want, at the end of his or her life. The drafter should think about how much he or she values being independent and self-sufficient. He or she should also consider whether it would be desirable to extend life in any situation, or only when there is a possible cure. These wills address treatments such as resuscitation, mechanical ventilation, tube feeding, dialysis, antibiotics or antivirals, comfort or palliative care, organ and tissue donations, or donating one’s body to science. The drafter should discuss each of these treatments with his or her treating physician to fully understand the implications of each.     

One does not need an advance directive or living will to have a do not resuscitate (DNR) or do not intubate (DNI) order. Preferences regarding these orders can be simply relayed to one’s physician, who will reflect the preferences in the patient’s medical record. If one does have a living will, however, it should mention whether the drafter has a DNR or DNI order on file.

Without these legal documents, family members and medical providers can become stressed and unsure about medical decisions, potentially creating or exacerbating serious conflicts during an already difficult time. The requirements for these documents vary by jurisdiction, so it is best to consult a lawyer. Most lawyers in the area of estate planning include a living will and health care directive in their typical estate planning services.