Living Will / Advanced Health Care Directive

An advanced healthcare directive (also called a living will) is a document that allows a person to write up their wishes for their end-of-life care, including appointing someone to make health care decisions for them, what kind of medical interventions and treatments they do and do not want, and what should happen to their body after they die.

In general these two terms are used interchangeably, but an advanced health care directive tends to be more comprehensive and a living will can be seen as a type of advanced directive. That said, both documents serve the same purpose and accomplish the same goals.

Not all living wills or advanced health care directives must cover all these topics, but these are the most common circumstance you’ll want to think about and include:

Power of attorney

One major component of a living will is assigning power of attorney over your health care decisions. This person is sometimes called an attorney-in-fact, durable power of attorney, or health care proxy. This person you choose is often a spouse or close family member, but it can be anyone you trust to carry out your wishes and make decisions with your best interest and values in mind. When you become unable to speak and make choices for yourself, this person automatically takes over in your stead.

Appointing a health care proxy is necessary because even though you will have written out your wishes, there are often unforeseen circumstances that will come up that your directive doesn’t cover and they will have to make these new decisions for you. You may choose to assign contingent proxies if your first choice is unable to perform the role for you.

CPR/resuscitation

Do you wish to be resuscitated with CPR or a defibrillator if you stop breathing or your heart stops beating? You can specify circumstances for this or state how long such measures should be used before stopping.

Palliative care

Palliative care is an overarching term that covers anything that makes your life more comfortable and reduces pain while you are in your last days of life. What do you want this to look like? Is there a time when you would want to be at home instead of the hospital? Would you want to receive intravenous pain medication?

Ventilators

Would you want to be put on a ventilator if your lungs were not able to properly function, and if so, how long and under what circumstances?

Tube feeding

Tube feeding either directly to your stomach or intravenously is sometimes used in end-of-life care. Would you want to be fed in this manner and if so, for how long?

Donation

You can also use a living will to stipulate any organ or tissue donation as well as if you’d like to donate your body to the hospital.

Payment of services

Unfortunately, end-of-life care can be very expensive in the United States and if you are not prepared for the costs, your family will have to cover them. One thing an advanced directive can do is stipulate how your medical bills will be paid. This can be done by selling your assets, or taking payments from insurance policies or investment accounts.

It’s worth noting that although you can include DNRs (do not resuscitate) or DNI (do not intubate) guidelines in your directive, you don’t have to have one for your wishes to be honored. You can always tell your physician or the doctor when you are admitted to the hospital and they will put this in your records.

Most people can make an advanced health care directive without the aid of an attorney, but you can always consult one for guidance and language suggestions.

Each state will have slightly different requirements, but they will all need to be in writing, be signed, and often need to be witnessed and in some cases notarized. You can find online versions of these forms for your specific state that will walk you through the steps and prompt you about routine end-of-life care situations.

You will also want to talk with your physician about your wishes in advance so they know your wishes and can help you with any medical language to make your directives clear.

After you complete your directive and have it witnessed/notarized as needed, make copies and provide them to the following people:

• Your physician
• Your named health care proxy
• Your spouse and any other immediate family or friends who are likely to be involved in your end-of-life care
• Retain one copy for yourself and put it in a safe location
• Your original should be kept in a safe deposit box or somewhere else where it will be protected
• Always bring a copy when traveling

You should also revisit your directives periodically to update them, especially when major life events happen. Good times to update your living will is when you get divorced, when you have a child, when you receive a new medical diagnosis, when you need to change your health care proxy, or about every ten years.

These documents are an essential part of anyone’s comprehensive estate planning and will provide peace of mind for you and your family. In times of grief and stress, the last thing you want for your family is to have to make hard decisions about your care that not all family members may agree upon. Creating and maintaining a living will is the responsible thing to do.