A Guide to Creating a Living Will

An advance health care directive, also called a living will, is a legal document that states your wishes regarding medical treatment if you become unable to make decisions for yourself. Preparing a living will is essential for all adults because accidents or sudden illnesses can happen unexpectedly, rendering you incapacitated. The COVID-19 pandemic has highlighted how unpredictable health can be and underscores why having a living will is vital for you and your family.

When Does a Living Will Take Effect?

A living will becomes effective only when you are medically diagnosed as incapacitated. Depending on your state, one or two doctors make this determination. It is crucial to inform your family where you keep your living will so it can be presented to medical professionals promptly. Having your medical care boundaries predetermined can relieve your family from making difficult decisions during stressful times.

Treatment Options to Consider in Your Living Will

• Do you want all possible treatments to try to save your life?
• Do you want treatments but with a timeline to stop if they are ineffective?
• Do you prefer treatments that avoid pain or discomfort?
• Do you want only palliative (comfort) care, focusing on pain relief without life-prolonging treatments?

More Detailed Medical Treatment Decisions

• Treatment types: Specify treatments you always want (e.g., pain medication) and those you want to refuse (e.g., dialysis or long-term ventilator care).
• Short-term vs. long-term treatments: For example, you may accept a temporary feeding tube after surgery but refuse permanent use after severe brain injury.
• Invasive tests and procedures: Some treatments, like blood transfusions or surgeries, may prolong life but cause discomfort. Consider if you want these.
• Feeding tubes: Artificial hydration and nutrition via tubes if unconscious or unable to swallow.
• Life support: Includes dialysis or ventilator support to sustain failing organs.
• CPR and DNR: Without a Do Not Resuscitate (DNR) order, emergency responders will perform CPR and electric shocks to restart your heart. A DNR is a legal physician order and can be part of your living will.

When to Limit Treatments

Consider limiting treatments when they severely reduce quality of life with little hope of recovery. Examples include:

• Wheelchair-bound without walking ability
• Constant severe diarrhea or nausea
• Incontinence requiring full care
• Dependence on ventilators or feeding tubes
• Kidney dialysis dependence
• Cognitive impairment preventing communication or recognition of loved ones
• Severe or constant pain

Other Important Considerations

A living will cannot cover every possible medical scenario, but it can address key questions such as:

• Your wishes if in a persistent vegetative state or coma
• Importance of pain relief vs. maintaining awareness
• Religious or personal beliefs affecting medical decisions
• Who you want as support during your care
• Preference for hospice care facility or home care

Facing these questions can be difficult but also brings peace of mind when clearly documented.

Discussing Your Living Will

Talk openly with your family, healthcare providers, and an estate planning attorney about your wishes. They can help clarify your preferences and ensure your living will complies with state laws. If you disagree with your doctor’s recommendations, seek another opinion to uphold your wishes.

Include instructions about funeral arrangements, burial or cremation, and preferred place of passing if possible. Inform all relevant parties that you have a living will and keep copies accessible. Many states offer registries for storing advance directives accessible by healthcare professionals.

Creating and Reviewing Your Living Will

You can create, update, or cancel your living will at any time while mentally competent. To replace an existing living will, formally revoke the old one and distribute copies of the new document to your family and healthcare providers.

Review your living will when life circumstances change, such as:

• Entering a new decade of life (e.g., 30s, 40s, 50s)
• Divorce or major family changes
• Death of a spouse or close relative
• Serious medical diagnosis
• Declining health affecting self-care abilities

Why Everyone Needs a Living Will

Life is unpredictable. Preparing a living will benefits you and your loved ones by ensuring your medical care aligns with your values if you become incapacitated. It reduces the decision-making burden on family during emotional times. This document is important not only for seniors but also for younger adults who face higher risks of accidents or sudden illness.

Start your planning today with the guidance of an experienced estate planning attorney.