Table of Contents
- The Definition: What is a Living Will?
- Do I need a Will?
- How to Create a Will
- What are the Consequences of Not Having this Document?
- How is a Living Will, Living Trust, and Durable Power of Attorney Different?
- Download a State-Specific Living Will Form
1. The Definition: What is a Living Will?
A Living Will is a legal document that leaves instructions about your preferences for end-of-life care and medical treatment. Unlike a traditional Last Will and Testament, a Living Will takes effect when you are still alive but unable to communicate your medical wishes if you ever become terminally ill or unconscious. If you’re still unsure about how exactly these two documents differ, make sure to read more about the differences between a Living Will and a Last Will and Testament.
With this advanced directive, your family members and health care providers know your preferences about:
- Organ or tissue donation
- Extended artificial life support
- The use of dialysis and breathing machines
- Resuscitation if your breathing or heartbeat stops
- What should happen if your doctor determines there is no recovery
- When, if ever, would you refuse medical care
As a reference, this document goes by other names:
- Advance Decision
- Advance Directive
- Advance Medical Directive
- Advance Health Care Directive
- Directive to Physicians
- Personal Directive
2. Do I Need a Will?
I should create a Will if I am…
- Over the age of 18 years old
- Military personnel being deployed overseas
- Traveling abroad for an extended period of time
- Undergoing surgery or will be entering the hospital for any reason
- Diagnosed with a terminal medical condition or illness
- Undergoing continuous medical treatment by a physician or medical team
- Growing wiser and older but concerned about your current health
- Wanting your family members know how you want to be medically treated
- Engaged in a high risk profession (i.e. firefighter or police)
- Creating an estate plan along with a traditional Will and Power of Attorney
- concerned about the following questions and would like my family members and healthcare providers to know my preference on each:
- How long would you want to be on artificial life support?
- Do you want to be resuscitated after suffering from a cardiac arrest?
- Would you prefer to pass away “naturally” or Allow Natural Death (AND)?
- Are you okay with ventilators and feeding tubes but not intubation?
- How do you feel about patient comfort and pain management?
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3. How to Create a Will
A simple living will should generally have at least the following:
1. End-of-life preferences
If you become terminally ill or injured, this document directs your doctor to either continue or withhold life sustaining treatment.
How would you answer these questions?
If you became terminally ill or permanently unconscious:
- Do you want treatment that would keep you alive but not cure you?
- Do you want food and water provided through a tube or an IV?
- Do you want dialysis to regulate fluids if your kidneys stop?
- Do you want antibiotics or antiviral medicine to fight infections?
- Do you want want your heart to be restarted with CPR or a defibrillator?
- Do you want a mechanical ventilator to help you breathe? For how long?
- Do your religious beliefs prohibit certain life sustaining procedures?
- How do you feel about amputation or blood transfusions?
Your doctor and another doctor decide that you have a condition that cannot be cured and that you will likely pass away in the near future from this condition. Given this unfortunate circumstance, how do you wish to be treated?
3. What does it mean to be permanently unconscious?
Your doctor and another doctor (one of whom is qualified to make such a diagnosis) agree within a reasonable degree of medical certainty that:
- you can no longer think
- you can no longer feel anything
- you can no longer knowingly move, or
- you are no longer aware of being alive
The doctors believe that this condition will last indefinitely without hope for improvement and have watched you long enough to determine that you are permanently unconscious.
4. What is life sustaining treatment?
Life sustaining treatment includes drugs, machines, or medical procedures that would help keep you alive but not cure you. Those who may refuse life sustaining treatment may prioritize quality of life in the final days of being alive.
Here are some examples:
- Resuscitation: CPR or a defibrillator could restart your heart if it stopped
- Mechanical ventilation: a machine helps deliver oxygen into the body
- Tube feeding: an IV or tube delivers nutrients and fluids to the body
- Dialysis: if kidneys stop, dialysis removes waste from blood
- Antibiotics: fight infections with medicine or let infections run the course
Even if you do not want life sustaining treatment, you can make sure the doctor will still administer comfort care or palliative care, such as medicine and treatment that eases your pain and keeps you comfortable.
5. Organ Donation
This document allows you to specify whether you want to donate your body, organs, and/or tissues for transplantation or medical research. The body is temporarily kept on life-sustaining treatment until organs are removed for donation. Alternatively, you can specify a scientific study at a local medical school or university to donate your body. According to the Australian government’s Organ and Tissue Authority, most religions (except for Romanis/Gypsies and Shintos) accept organ donation and transplantation.
A 2013 article by the Emory Transplant Center breaks down the Pros & Cons of Organ Donation, while a 2009 Wall Street Journal article describes some of the downsides associated with receiving organ transplants.
You must generally have two witnesses present and sign the document. Witnesses to the document may NOT be related to you either by blood or marriage. In other words, your witnesses cannot inherit part of your estate if you pass away.
The following people may NOT be your witness:
- Relative by blood or marriage
- Named in your will
- May inherit part of your estate
- Your attending physician or health facility
7. What else should I know when preparing this document?
If you or a loved one enters a hospital, nursing home, or hospice care, you may be interested in a Physician Order for Life Sustaining Treatment (POLST), a document that states end-of-life wishes about intubation, antibiotic use, and feeding tubes. Similar to a Do Not Resuscitate (DNR) order to withhold CPR or advanced cardiac life support, a POLST must be signed by your doctor.
Other names for a POLST include:
- MOLST: Medical Orders for Life-Sustaining Treatment (CT, MA, MD, NY, OH, RI)
- POST: Physician Orders for Scope of Treatment (WV)
- COLST: Clinician Orders for Life Sustaining Treatment (VT)
A POLST or similar medical orders travel with you and become a part of your medical records. Your health care professionals and medical team will then be able to follow these medical orders. If your health care improves, you can change or cancel the medical orders at any time.
4. What are the Consequences of Not Having this Document?
Without this document, your family members or health care providers may not know your medical preferences or how to execute them if you are unable to communicate. In the worst case, those around you may actually disagree with your end-of-life wishes.
Coupled with a Medical or Healthcare Power of Attorney, this will allows you to take back control and proactively choose how YOU want to be taken care of during a medical emergency.
By taking the time to create this document, you can reduce and prevent suffering.
Preventable Suffering by Having a Living Will
|1. LOSS OF CONTROL||1. LOSS OF CONTROL|
|Medical treatment is made without your consent||Unable to administer your family member's wishes|
|Life support is started, maintained, or ended||Disagreement with physician or health care providers|
|Your wishes are not respected||2. EMOTIONALLY BURDENSOME|
|2. PROLONGED PHYSICAL PAIN||Family members disagree on length of life support|
|Family or doctors are unable to respond quickly||Additional stress on family members about making life and death decisions for you|
|Medical procedures that increase pain may be used||3. COST BURDENS|
|Family members quit work to care for family in a coma|
5. How is a Living Will, Living Trust, and Durable Power of Attorney Different?
Living wills can often get confused with Living Trusts and Durable Power of Attorney documents.
Living Wills: Outlines your preferences for end-of-life healthcare treatments.
Living Trusts: Places your chosen assets in a trust and names a ‘successor trustee’ to transfer the assets upon death according to your wishes. The main advantage that a trust has over a last will is that avoids probate, which is a court proceeding whereby a will is deemed valid or invalid.
Durable Power of Attorney for Healthcare: Designates an ‘agent’ to make medical decisions when a you cannot act on your own behalf. Your healthcare agent will ensure that your doctors give you the care you wish to receive.
6. Download a State-Specific Living Will Form Sample
The basic elements of this document are:
- Declarant: adult of sound mind who expresses their end of life wishes
- Artificially Provided Nourishment and Fluids: feeding tubes removed
- Organ Donor Certification: organs and/or tissues donate
- Effective Date: when the document begins, usually immediately
- Witnesses: generally at least two non-relatives must sign the form
- Notary Public: weighty significance of a this document requires a notary
- Signatures: the Declarant, witnesses, and notary public must all sign
With that being said, the contents of this advanced directive are subject to change depending on the state you live in. To download a state-specific living will form, click the you state you live in on the map below:
Download Your Living Will By State
The living will sample below specifies Mr. Connor Delaney’s end of life preferences. In the event that Mr. Delaney finds himself in a terminal condition, he does not want his life to be artificially prolonged. Keep in mind that this Mr. Delaney’s living will is in accordance with law in the District of Columbia.