What is a living will and who should have one?
Discussions about end-of-life and critical-care issues are never easy and often get put aside because no family members are ever at that stage, but planning ahead can prevent confusion, conflict and unnecessary suffering during times of worry and grief.
Knowing a loved one’s wishes before an illness or accident ensures that family members won’t have to make difficult choices on the loved one’s behalf during a crisis.
Livings Wills Are Legal Instructions
Also called advance directives or healthcare directives, living wills are written, legal instructions detailing a person’s preferences for medical care if he or she is unable to make decisions. Advance directives guide healthcare choices for medical professionals and caregivers if a person is terminally ill, critically injured, in a coma, in the late stages of dementia or near the end of life.
Advance directives aren’t just for older adults. Because unexpected critical-care and end-of-life situations can occur at any age, it’s crucial for all adults to prepare these documents.
Studies show that older adults feel especially relieved to know that their specific and personal end-of-life preferences are documented and will be carried out, therefore freeing their families from making these decisions.
Living Wills and Power of Attorney
A living will typically works together with a medical power of attorney (POA). Some states combine the two into one document. The medical POA enables a person to select somebody (a spouse, other family member, or a trusted friend) to make medical decisions on his or her behalf. These two documents can allow you to control the types of medical treatment you’ve chosen, and who will make sure your wishes are honored.
Which Medical Treatments Should You Think About?
The living will typically spells out medical treatments you would or would not want to be used to keep you alive, as well as other options such as pain management and organ donation. Talk to your doctor, healthcare agent (the person with POA), your family, and friends about your personal wishes. Would you want to extend treatment in any situation? Would you want treatment only if recovery is possible?
These are some of the primary issues to consider:
- Resuscitation to restart the heart. You don’t need a living will to have do not resuscitate (DNR) and do not intubate (DNI) orders. These orders can be prepared separately and put in your medical record.
- Mechanical ventilation to take over breathing if you can’t breathe on your own.
- Tube feeding to supply the body with nutrients and fluids intravenously or through a tube in the stomach.
- Dialysis if your kidneys cease to function.
- Antibiotics or antiviral medications used near the end of life.
- Palliative care to keep you comfortable and manage pain at end of life, including being allowed to die at home, getting pain medications, being fed ice chips to soothe dryness, and avoiding invasive tests or treatments.
- Organ and tissue donation for transplantation.
- Donating your body for scientific study.
What is a POLST?
POLST stands for Physician Orders for Life Sustaining Treatment. It is a form that summarizes a person’s wishes for critical treatments in the form of medical orders signed by a physician. The form is intended as a complement to advance directives not to replace it.
