Living wills or advance care directives are legal documents enabling people to state their wishes for end-of-life medical care, especially if they are unable to express informed consent.
Imagine you're in intensive care at a hospital with a life-limiting illness and unable to communicate. Despite the best medical care, it's unlikely you'll leave the hospital alive. The medical team can prolong your breathing and heart function by using artificial life support.
Is this the kind of treatment you want for yourself?
Do you want to leave these end-of-life decisions up to your loved ones or doctors—with no guidance from you?
While we strive to be independent and maintain control of our lives, some of us may not have a say in our own care during a debilitating illness. An advance directive makes your wishes known.
First steps includes clear and honest conversations with your family. Look for opportunities to help them understand how an advance directive in your medical record may spare them the anxiety of guessing your preferences during a medical crisis.
A survey by the Kaiser Family Foundation reported that 97 percent of people said it's important to have end-of-life preferences in writing, however, only 34 percent have actually done it. The Conversation Project Starter Kit is a free guide to sharing your wishes for end-of-life care.
Two vital documents for your advance directive are a living will and a health care proxy form. Some states combine these documents into a single form.
A living will is an advance care directive that spells out medical treatments you would want, or would not want, if you couldn't speak for yourself. You do not need a lawyer to complete a living will.
Some of the important medical decisions in a living include whether or not you want specific life-prolonging medical treatments at certain stages of end-of-life care. For example:
- Do you want CPR if it's unlikely you'll ever regain consciousness or you're at the end-stage of a terminal illness?
- At what point should doctors withhold a respirator or feeding tube to extend life?
- Would you want kidney dialysis if your kidneys fail?
Advance directive rules are different for almost every state. Search for advance directive and your state's name
A health care proxy, also called power of attorney for healthcare, medical power of attorney or a healthcare agent, is a person you choose to make health care decisions, if you cannot make them for yourself. Many states enable you to quickly complete this specific document. Search "healthcare proxy forms" and your state's name.
Some advance directives may include spiritual requests, organ donation information and choices for emergency treatments, such as Do Not Resuscitate orders.
- Make copies of your advance directive and share two copies with proxies or agents named in your directive or power of attorney.
- Make a print copy for your primary care doctor and send a digital version to the office or through your healthcare portal.
- Talk about your wishes with family members and your doctor.
- Keep a copy at home and let family or other loved ones know its location.
A Physician Orders for Scope of Treatment (POST or POSTL) is a set of instructions for health care professionals to recognize and honor a patient's treatment preferences for life-sustaining measures, such as CPR, a breathing tube and feeding tube.
POST forms are typically for terminally ill or frail seniors who want to ensure their end-of-life wishes are followed by emergency personnel, doctors and medical staff. The POST form is not a substitute for a more inclusive advance directive. Living wills and health proxy forms are more relevant for people in good health.
How is a POST form different from a DNR?
A Do Not Resuscitate (DNR) order is a one-page document focused only on a person's preference to not receive cardiopulmonary resuscitation (CPR) if they stop breathing or their heart stops beating. The DNR does not address other medical treatments.