The advance health care directive, also known as a living will, is a legal document that specifies how you want medical professionals to act if you are unable to do so due to an accident or illness. A living will is crucial for all adults because accidents or a sudden onset of severe or terminal illness can happen anytime, rendering you unable to make medical choices. The COVID-19 pandemic is an example of how unpredictable your health can be and why preparing your living will is vital for you and your family.

A living will only take effect in the event of medically diagnosed incapacity; depending on your state, one or two doctors will make this determination. Your family should know where you keep your living will to present to the hospital if necessary. Having predetermined your boundaries for medical care will provide great relief to your family during the heightened emotional time of dealing with a loved one’s incapacity.

Treatment Options to Consider When Preparing Your Living Will

• Do you want all treatments available to try to save your life?
• Do you want all treatments but add a timeline to stop them if they are not working?
• Do you only want treatments that cause no pain or discomfort?
• Do you prefer only palliative (comfort) care? Palliative care will provide only medication to alleviate pain but not treatments to prolong or save your life.

More Detailed Medical Treatment Decisions

• Treatment types – There may be treatments you always want to have, such as pain medication. There are also those you may never want to receive, such as dialysis or long-term ventilator care.
• Short and long-term treatments – If a short-term treatment provides a good chance of getting better, you may want that. For example, if you are recovering from surgery, you might opt to have a feeding tube for a short while. Alternatively, if you sustain a severe and long-term brain injury, you may not want a permanent feeding tube. You can create time limits for life-sustaining treatments so that you do not linger in a vegetative state if treatments remain unsuccessful.
• Invasive tests and treatment options – Many of these procedures create discomfort and pain. Lab tests, antibiotic treatment, blood transfusions, and surgery may prolong your life even when recovery is no longer possible. You may not want to receive a blood transfusion if you are not COVID-19 vaccinated because of the risk of receiving blood with the mRNA vaccine.
• Feeding tubes – This procedure, also known as artificial hydration and nutrition, can sustain your body if you are unconscious or can’t swallow. A tube from which the sustenance flows is put into your stomach by a health care provider.
• Life support – If some of your organs are no longer functioning, life support treatments can help sustain the function of the damaged organ. If your kidneys don’t work, you can receive dialysis to remove impurities and wastes from your blood, or if you can’t breathe, you may be placed on a ventilator.
• CPR and DNR – Without specific instructions to disallow CPR or electric shock, which attempts to restart your heart if it stops beating, healthcare emergency responders and medical providers will use these techniques to save your life. A DNR (do not resuscitate) is a legally binding physician order and can be part of your living will. A copy of your DNR order needs to also be on file with your medical records.

Limiting Certain Treatments

Certain situations can occur where you may want to limit treatments because of the degradation to your quality of life and little hope of getting better:

• You can use a wheelchair, but you can’t walk
• You experience constant and severe diarrhea or nausea
• You are unable to control urination and bowel movements
• You require caregivers to bathe, and help you with toileting, dressing, and feeding
• You need a ventilator to breathe
• You need a feeding tube to eat
• You require kidney dialysis to survive
• You can’t think straight or communicate effectively
• You no longer recognize family and friends
• You experience severe or constant pain

Other Questions to Ask

A living will is instructive but can’t possibly determine every scenario for an end-of-life situation; however it can include important ones. Consider what medical intervention you would want if you were in a persistent vegetative state or long-term coma. Do you have fears about your life ending? Is pain relief crucial to you, or do you want to remain alert and awake even if experiencing pain? Do you have religious or other beliefs that should be followed before you die? Who do you want with you as support? Do you want to be in a hospice care facility or at home? Questions that strike at the heart of mortality can be unsettling, but you may find a sense of peace when you have confronted and described them in a living will.

Talk About Your Choices

Speak to your family, estate planning attorney, and healthcare providers about your wishes. Sometimes they might challenge your thoughts or ask questions that help you better prepare your living will. If you are at odds with a medical doctor and can’t agree, it is best to seek new medical care to support your wishes. Include aspects for funeral arrangements, burial or cremation, and where you want to be when you die (if that is an option). Your estate planning attorney can explain your state’s legal requirements regarding signature, witnesses, and other rules.

Tell your family, friends, and healthcare providers that you have a living will and keep legal copies on file in the appropriate places. Health care providers should put a current copy in your medical records at your hospital. Keep your original document in a safe place but also one that is easy to find. Some states have registries that store copies of your living will and other advance directives, and some will even provide healthcare workers access via computer. Some houses of worship may also store a copy of your living will for you. Talk to your estate planning attorney for input regarding your situation.

Creating and Reviewing Your Living Will

When do you create or review your living will? Since a living will only go into effect when you are deemed medically incapacitated, you can create one and change or cancel it at any time. Once completed, your living will is a legal document, and you can’t just tear up your copy and think existing copies will not be relevant. You must legally cancel your last living will to create a new one or have your lawyer make changes and provide copies of the new living will to family, healthcare providers, or wherever else you keep copies.

A good rule to follow for reviewing your living will include:

• Decade – At the beginning of each new decade of your life (the 30s, 40s, 50s, etc.)
• Divorce – Significant changes to your family or personal relationships
• Death – Your spouse or a close relative dies
• Diagnosis – You receive a diagnosis of a serious disease or health condition
• Decline – Your health diminishes, and you find self-care harder

Life is an uncertain experience. Those things you can control through legal preparation will benefit you and your family if you become incapacitated. Having a living will is for all adults, not just seniors. Younger individuals may take more risks and experience higher incidences of accidents, leaving them unable to make medical care decisions. Whatever your adult age preparing a living will brings peace of mind, protect your medical future as you wish, and reduces the decision-making burden on your family and loved ones. Get started with an estate planning attorney to implement this critical document. We hope you found this article helpful. If you have questions or would like to discuss your legal needs please contact us at (270) 483-3001.