Living wills and advance directives for medical decisions
Living wills and advance directives describe your preferences for end-of-life care. These documents speak for you when you're not able to speak for yourself.By Mayo Clinic Staff
Living wills and other advance directives are written, legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself. Advance directives guide choices for doctors and caregivers if you're terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.
By planning ahead, you can get the medical care you want, avoid unnecessary suffering and relieve caregivers of decision-making burdens during moments of crisis or grief. You also help reduce confusion or disagreement about the choices you would want people to make on your behalf.
Advance directives aren't just for older adults. Unexpected end-of-life situations can happen at any age, so it's important for all adults to prepare these documents.
Power of attorney
A medical or health care power of attorney is a type of advance directive in which you name a person to make decisions for you when you are unable to do so. In some states this directive may also be called a durable power of attorney for health care or a health care proxy.
The person you name may be a spouse, other family member, friend or member of a faith community. You may also choose one or more alternates in case the person you chose is unable to fulfill his or her role.
Depending on where you live, the person you choose to make decisions may be called one of the following:
- Health care agent
- Health care proxy
- Health care surrogate
- Health care representative
- Health care attorney-in-fact
- Patient advocate
Choosing a person to act as your health care agent is important. Even if you have other legal documents regarding your care, not all situations can be anticipated and some situations will require someone to make a judgment about your likely care wishes. You should choose a person who meets the following criteria:
- Meets your state's requirements for a health care agent
- Is not your doctor or a part of your medical care team
- Is willing and able to discuss medical care and end-of-life issues with you
- Can be trusted to make decisions that adhere to your wishes and values
- Can be trusted to be your advocate if there are disagreements about your care
A living will is a written, legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as other decisions such as pain management or organ donation.
In determining your wishes, think about your values, such as the importance to you of being independent and self-sufficient, and what you feel would make your life not worth living. Would you want treatment to extend life in any situation? Would you want treatment only if a cure is possible?
Have discussions with your primary care doctor, your health care agent, family and friends about your personal wishes. Resources for organizing your own thoughts and having conversations with others about medical care and end-of-life care are available through the American Bar Association, the Conversation Project and the Center for Practical Bioethics.
You should address a number of possible end-of-life care decisions in your living will. Talk to your doctor if you have questions about any of these issues:
- Resuscitation restarts the heart when it has stopped beating. Determine if and when you would want to be resuscitated by cardiopulmonary resuscitation (CPR) or by a device that delivers an electric shock to stimulate the heart.
- Mechanical ventilation takes over your breathing if you're unable to do so. Consider if, when and for how long you would want to be placed on a mechanical ventilator.
- Tube feeding supplies the body with nutrients and fluids intravenously or via a tube in the stomach. Decide if, when and for how long you would want to be fed in this manner.
- Dialysis removes waste from your blood and manages fluid levels if your kidneys no longer function. Determine if, when and for how long you would want to receive this treatment.
- Antibiotics or antiviral medications can be used to treat many infections. If you were near the end of life, would you want infections to be treated aggressively or would you rather let infections run their course?
- Comfort care (palliative care) includes any number of interventions that may be used to keep you comfortable and manage pain, while abiding by your other treatment wishes. This may include 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 donations for transplantation can be specified in your living will. If your organs are removed for donation, you will be kept on life-sustaining treatment temporarily until the procedure is complete. To help your agent avoid any confusion, you may want to state in your living will that you understand the need for this temporary intervention.
- Donating your body for scientific study also can be specified. Contact a local medical school, university or donation program for information on how to register for a planned donation for research.
Do not resuscitate and do not intubate orders
You don't need to have an advance directive or living will to have do not resuscitate (DNR) and do not intubate (DNI) orders. You can make your preferences known to your physician, who can write the orders and put them in your medical record.
If you have a living will, however, be sure to mention it it whether you have a DNR or DNI order on file.
Nov. 11, 2014
See more In-depth
- Advance care planning: Ensuring your wishes are known and honored if you are unable to speak for yourself. http://www.cdc.gov/aging/pdf/advanced-care-planning-critical-issue-brief.pdf. Centers for Disease Control and Prevention. Accessed April 30, 2014.
- Giving someone a power of attorney for your health care: A guide with an easy-to-use, legal form for all adults. American Bar Association. http://www.americanbar.org/groups/law_aging/resources/health_care_decision_making/power_atty_guide_and_form_2011.html. Accessed April 30, 2014.
- Put it in writing: Questions and answers on advance directives. American Hospital Association. http://www.aha.org/advocacy-issues/initiatives/piiw/index.shtml. Accessed April 30, 2014.
- Consumer's tool kit for health care advance planning. American Bar Association. http://www.americanbar.org/groups/law_aging/resources/health_care_decision_making/consumer_s_toolkit_for_health_care_advance_planning.html. Accessed April 30, 2014.
- Making your healthcare wishes known. Center for Practical Bioethics. http://www.practicalbioethics.org/resources/caring-conversations. Accessed May 8, 2014.
- The Conversation Starter Kit. The Conversation Project. http://theconversationproject.org/starter-kit/intro/. Accessed April 30, 2014.
- Advance care planning: Tips from the National Institute on Aging. National Institute on Aging. http://www.nia.nih.gov/health/publication/advance-care-planning. Accessed April 30, 2014.
- Strong CW. Avoiding confusion: Pay attention to donation language in an advance directive. United Network for Organ Sharing. http://www.unos.org/docs/Update_SepOct10_InAdvance.pdf. Accessed April 30, 2014.
- FAQ. National POLST Paradigm. http://www.polst.org/advance-care-planning/faq/. Accessed May 9, 2014.
- FAQ: The POLST form. Minnesota Medical Association. http://www.mnmed.org/Advocacy/Key-Issues/POLST-Communications. Accessed May 9, 2014.
- POLST: Provider orders for life-sustaining treatment. Minnesotat Medical Association. http://www.mnmed.org/Portals/mma/PDFs/POLSTform.pdf. Accessed May 9, 2014.
- AskMayoExpert. Do not resuscitate (DNR) or do not intubate (DNI) order. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.