What Can I Cover in My Living Will?
Both federal and state law give you the power to direct your own medical care. This means that you can say whether you want life-support measures -- such as a respirator or feeding tubes -- at the end of your life.
In truth, you could use a pen and the back of a napkin to scribble a wish that you not be placed on life support and, if those wishes were "clear and convincing," the law would honor them. But have no doubt: The best place to write out your health care wishes is in a living will. By clearly expressing your wishes in a document approved by your state, you can remove confusion and potential conflict from a stressful situation.
What, exactly, can you cover in your living will? Here are the main issues to consider.
Life-Sustaining Medical Treatment
The primary purpose of a living will is to tell others whether you do or don't want life support when your death is inevitable. Your wishes will take effect when doctors decide that you are close to death from a terminal condition, or if you are in a permanent coma.
When considering types of life support, most people think of a respirator and feeding tubes. But life-prolonging care may also include treatments such as:
- cardiopulmonary resuscitation (CPR)
- blood transfusions or blood products
- kidney dialysis
- diagnostic tests
- medications, or
If you’re not sure what you want, you can discuss your feelings and concerns with a doctor you trust. Also, many hospitals and other care facilities have someone on staff trained to help with these issues. This person may be able to provide you with advance directive forms for your state and answer questions you have about filling them out.
There are also many places to learn about end-of-life care online. A good place to begin is Growth House, a central hub for many relevant resources on the Internet.
Many living will forms ask whether you want to receive “artificially administered food and water” at the end of life. That means nutrients and hydration supplied through an IV or tube.
The removal of feeding tubes can be such a controversial issue (the case of Terri Schiavo is one high-profile example) that it's wise to address your wishes about tube feeding separately from other types of life-sustaining treatment.
Deciding whether you want to receive artificially administered food and water may be difficult. Again, you may want to discuss the issue with a doctor or other trusted medical professional. You can find online information at the website of Hank Dunn, the author of the book Hard Choices for Loving People: CPR, Artificial Feeding, Comfort Care and the Patient With a Life-Threatening Illness.
Whatever directions you give in your living will, be assured that as long as your medical condition allows it and you can communicate your wishes -- even through gestures -- you will be given food and water.
Pain Relief or Palliative Care
You can say no to life-prolonging treatments at the end of life and still receive medication or other care to manage pain and keep you comfortable. In fact, most living will forms assume that you want pain relief and require you to make a statement only if you don’t want it.
Palliative care is a comprehensive program of treatment designed to ease pain and provide comfort. It goes beyond pain medication, focusing on a variety of ways to reduce symptoms while providing social, emotional, and spiritual support to patients and their families. Palliative care is commonly offered in hospice settings but, increasingly, it is available in hospitals and other care facilities as well.
When you make your living will, you may want to take some time to learn about palliative care. In addition to stating your wishes about pain medications, your living will is a good place to describe other wishes related to your comfort -- for example, whether you would like to hear your favorite music or have others read aloud to you, whether you want a counselor or spiritual adviser to visit you, or if there are certain belongings you’d like to have nearby. These are fine subjects for a living will, and they are also good topics for a conversation with your loved ones.
There are many good resources available to help you explore these issues. In addition to Growth House, mentioned above, you might want to explore On Our Own Terms (a website created by PBS) and the website of The National Hospice and Palliative Care Organization.
We also like The Conversation Project, which offers a “starter kit” to help you begin a discussion about end-of-life issues with those closest to you.
How to Make Your Documents
If you're ready to get started, see The Best Sources for Health Care Documents in the District of Columbia.