Living Will 101: What it is and why you need one

So what is a living will, and why have one?

The concept is fairly simple: A living will documents your medical wishes so that your doctor knows what to do should you become unable to communicate your desires for treatment. Having your medical wishes documented spares your loved ones from being forced to make difficult medical decisions, which is the most common reason for filling out a living will—you make the decisions for your family in advance.

“Living will” is not actually a legal term; it is a catch-all phrase which refers to the various documents each state uses for storing a patient’s medical wishes (eg. Texas calls it a Directive to Physicians while other states call it a Health Care Directive). Regardless, “living will” is a widely used and accepted term. To find the forms that your state uses, click here.

Similarly, “life support” is not a legal term. Life support refers to a variety of specific medical treatments. So, your living will cannot simply say that you do or do not want “life support”—more specific answers are required. Here are some examples of situations in which a living will would come into play:

You’ve had a stroke: You cannot communicate, you are not responsive to stimuli or you are unable to answer questions at all. Despite the loss of these cognitive functions, your heart continues to beat normally, and could do so indefinitely. Would you want to receive artificial hydration and nutrition to keep your body functioning? This would involve implanting a tube for feeding. Would you want that?

You have dementia: Your dementia has progressed and your cognitive function has deteriorated to the point that you can no longer answer questions logically. You recognize neither the people around you nor your physical surroundings. Next, you develop breathing problems. Would you want to be put on a ventilator (a machine that breathes for you)? For how long?

Important Details

Your living will only comes into play if you cannot communicate. If you are still able to talk, blink your eyes, nod, shake your head or communicate your desires in any way, then you still get to choose what you want.

What happens if you don’t have a living will? Doctors will look to your available next of kin for instructions. This could be your spouse, your children or a sibling. Your next of kin would then be responsible for deciding whether to start or continue specific treatments. This often leads to family disagreements at a difficult time when emotions are running high. A living will can relieve your family of that responsibility.

If you are not sure what specific treatments or procedures you want, then you can leave those decisions to your loved ones. But, leaving decisions to your loved ones does not negate the importance of having a conversation with your family about how you feel about “life support” in general. (You can also designate a specific family member to make medical decisions via a Medical Power of Attorney, which is different from a living will.) Also, a living will can be revoked at any time if you change your mind.

Living wills are easily accessible, are usually simple to complete and do not require the presence of an attorney. If you are at a facility and need living will forms, ask to see a social worker or case manager. Many facilities will provide the forms at admission.

By Julie Coats, LBSW, CCM