Living Will Health Article

Definition

A living will is a legal document in which patients instruct health-care providers about their wishes with respect to medical procedures should they become incapacitated. The living will and the durable medical power of attorney are two federally mandated parts of what is known as advanced medical directives.

Purpose

Advanced medical directives are legal mechanisms to assure that patients' wishes with respect to a number of medical procedures are carried out in their final days or when they are incapacitated. The documents reflect patients' rights of consent and medical choice under conditions whereby patients can no longer choose for themselves what medical interventions they wish to undergo.

In 1990, recognizing the importance of patient treatment wishes at the end of life, Congress enacted the Patient Self-Determination Act (PSDA). This federal law ensures that patients admitted to hospitals, nursing homes, home health agencies, HMOs, and hospices be informed of their rights under state law to prepare advance health care directives and have the documents entered into their medical record. Each state has different requirements for the living will and the power of attorney. It is important to research medical directives before an accident or illness make that an impossibility. Living wills have become customary in many parts of the country and are broadly respected by health care providers. However, a high percentage of Americans do not have a living will and/or a power of attorney to ensure its compliance.

Description

The living will can be a very broad or a very narrow document, according to the wishes of the patient. It is the patient's declaration, a written statement of what he or she wants to occur in the event of serious accident or illness. It is primarily directed to medical personnel about the type of care the patient wishes to have, or wishes not to have, under situations of terminal illness or incapacitation.

The document commonly includes the kinds of medical procedures that are usually administered to patients who are seriously ill. These may include:

• transfusions of blood and blood products
• cardiopulmonary resuscitation (CPR)
• diagnostic tests
• dialysis
• administration of drugs
• tissue and organ donation
• use of a respirator
• surgery

The living will declaration can also include issues of pain medication, food, and water. Most states recognize that relief from pain and discomfort are procedures that most people wish to have and these are not considered life-prolonging treatments. In some states, however, food and water may be considered life prolonging. and the consideration to forego them may fall within the rights of the patient to refuse. What may be included in the living will depends upon the state.

The living will—in some states called instructions, directive to physicians, or declaration—does not require a surrogate (an appointed person) to make decisions for the patient. Most states include these types of instructions in their medical durable power of attorney forms. Not all states, however, recognize separate living wills as legally binding; California, for instance, does not.