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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Summary

Since the publicity about Living Wills usually relates to people in a coma, it's easy to think of the document as useful only if you are in a coma but would want to tell your health care providers and loved ones: "Go ahead, I want you to pull the plug." or "Don't even think about touching that plug!"

While Living Wills do only relate to a terminal situation, Living Wills can be far more inclusive than "pull the plug." A Living Will tells your family and caregivers the level of care that you want if you can't communicate yourself.

A Living Will does not prevent your receiving treatment if you are not in a terminal situation. If your condition becomes terminal, a Living Will does not prevent the provision of pain relief or comfort care.

If you are considering a Living Will, also consider executing a Health Care Power of Attorney and a Do Not Resuscitate (DNR) Directive. The Healthcare Power of Attorneygives a trusted person the authority to make decisions in all the gray areas not covered in a Living Will. He or she will also help enforce the terms of a Living Will. The DNR covers the specific situation of what to do if you stop breathing. All three documents are complementary to each other.  NOTE: A Living Will can help guide the proxy under a Healtcare Power of Attorney if a question arises about what you would want if you could speak for yourself.

After signing a Living Will, it is advisable to take the steps necessary to assure that the wishes expressed in your Living Will are carried out.

For information, see:

What Is A Living Will?

A Living Will is a legal document which communicates your desires about your health care if you become unable to communicate by any means and the likelihood of death is imminent.

Virtually all states have laws requiring doctors and other health care providers to abide by what you provide in a Living Will if the document is properly executed.

In most states, even your close family members cannot override your wishes as expressed in a Living Will.

To be properly executed, a Living Will must meet each of the following requirements:

  • Conform to the laws in the state where you receive treatment.
  • Be signed by you at a time when you are competent to sign contracts and execute legal documents.
  • Be signed in the presence of witnesses and, in some states, a notary public.

Even if a Living Will is properly executed, it will have not become effective unless it is given to your doctor or other health care provider who is involved with your care when a decision about a treatment has to be made.

Why Do I Need A Living Will If I Have A Healthcare Proxy?

As you will see below, a Living Will usually only deals with directions to use or to withhold specific procedures in a situation where you are terminally ill and death is expected soon.

On the other hand, a Proxy has the ability to make decisions that cover the whole range of medical care and can act in situations where you may be incapacitated but are not terminal.

At least one of the documents should state what controls if there is a conflict between a Living Will and what the Proxy thinks is appropriate.

To Learn More

More Information

Healthcare Power of Attorney

Where Do I Find A Living Will Form For Use In The State In Which I Live?

Free Living Wills

The web site, wwwcaringinfo.org offsite link, contains free forms and the requirements for their execution for each state. To find a Living Will usable in your state, see: http://www.caringinfo.org/stateaddownload offsite link. You'll find the form under the general heading: "Advance Directives".

Hospitals and other medical facilities such as nursing homes and assisted living facilities which received Medicare or Medicaid funds have free Living Wills.

Another excellent source of your state's laws concerning Advance Directives are local non-profit organizations that serve seniors or people with a life-changing condition such as HIV/AIDS, cancer, or Alzheimer's.

Low Cost

Another reputable source is the Cancer Information Service, a program of the National Cancer Institute. If you call 800.422.6237 you receive information on how to order state specific documents. The minimal cost varies by state.

Five Wishes is a document that combines Living Wills acceptable in all 50 states with additional information and useful forms. Unlike other forms, the Five Wishes form allows you to specify that if certain life-support measures are started, they may be stopped if a doctor says that they are not doing any good. It also lets you specify whether you want to die at home or in a hospice. You can see and order the form at www.agingwithdignity.org offsite link. Cost: $5.00 per copy.

Sanctuary, Inc. also maintains Living Wills and similar forms and literature. Although the Living Will and Healthcare Proxy documents are free, Sanctuary requests a $25 donation with your order. Sanctuary combines a Healthcare Power of Attorney and a Living Will into one document. Sanctuary is located at 204-04 Hillside Avenue, Hollis, NY 11423. Telephone: 718.479.1000. www.healthproxylivingwill.org offsite link.

Many stationery, book, and office supply stores also sell forms that conform to your state's laws. Many of those stores carry forms geared to each state by Rediform  of Coppell, TX 75019 (their Durable Power of Attorney Kit is Legal Form 10175). If you are unable to locate a store that carries Rediform  products, you call the company's hotline at 800.234.7586. As of this writing, you cannot order forms through their website, but it may be worth checking when you read this. See www.rediform.com offsite link

If You Live In More Than One State

If you have residences in more than one state, it advisable to prepare (or ask an attorney to prepare) a separate document a document which is valid in each state in which you live. If this is not possible, or too cumbersome, create separate documents for each state.

Be sure each Living Will says the same thing so there is no confusion if it ever comes time to use the documents. The terms of your Living Will should also not conflict with the terms of your Healthcare Power of Attorney.

To Learn More

More Information

Healthcare Power Of Attorney

What Should Be In A Living Will?

A typical Living Will deals exclusively with end of life issues. It describes the live-saving procedures you do want as well as those you don't want in the event you are in danger of dying and unable to communicate your wishes.

To help decide what instructions to include in your Living Will, see: What Would I Want To Happen?

Some states have only permit a very general statement such as: "If I should have an incurable or irreversible condition that will cause my death within a relatively short time, and if I am unable to make decisions regarding my medical treatment, I direct my attending physician to withhold or withdraw procedures that merely prolong the dying process and are not necessary to my comfort or to alleviate pain." Other states allow you to insert specific directives or to check off specific instructions from a list of choices. A few have blank spaces and permit you to write your feelings and wishes, as well as give both general and specific instructions.

Consider including the following in your Living Will no matter what state you live in. You can write-in the provisions by hand to a form Living Will that doesn't have them.

  • Add a provision which specifically states that the Living Will does not apply to emergency situations from which you are reasonably expected to recover your previous quality of life.
  • In order to avoid a conflict between what is stated in your Living Will and your Health Care Proxy, include a statement concerning which controls in the event of a conflict. For instance: "In the event of a conflict between the provisions of this my Living Will and the decision of my Health Care Proxy, the (terms of the Living Will) (the decision of the Health Care Proxy) shall control." Be sure to include the same provision in your Health Care Power of Attorney. (To learn more, see What If My Proxy's Decision Conflicts With My Living Will?).
  • A statement to the effect that you and your heirs will not sue health care workers or facilities for following your stated wishes.
  • If you wish to be an organ donor, your Living Will should mention that you are an organ donor and give permission to temporarily suspend the terms of the document to preserve your organs for a transplant. (Also take whatever action is necessary in your state to be an organ donor).
  • If any provision or provisions contained in this document is/are deemed to be illegal, such provision(s) shall not affect the legality of the remainder of the document which shall continue in full force and effect.

If you don't want artificial nutrition or hydration, state the situations in which you don't want artificial nutrition or hydration. Don't use wording such as "don't want any artificial nutrition or hydration ever." There may be a situation in which such a treatment could be helpful temporarily. (Keep in mind, as Dr. Desiree Pardi stated:"... we know we need food and liquid to live. But we don't need them to die.")

To put a Living Will into effect, it needs to be completed and signed by you. Most states only require that the document be signed in front of witnesses. Even so, it is also a good idea to sign the document in front of a Notary Public to avoid unnecessary delaying questions if the need to use it arises.

NOTE: It is advisable to have a Health Care Power Of Attorney which appoints a Health Care Proxy to speak for you and to enforce your wishes. Be sure to let the Proxy know what your wishes are, and give him or her a copy of your Living Will.

Specific Procedures To Consider

If the state in which you live permits you to describe specific procedures, try to identify your wishes as specifically as possible so that little, if any, decision needs to be made by the people trying to carry out your wishes. For instance, instead of using a general phrase such as heroic measures which could mean any of a number of medical procedures, list your wishes about:

  • Artificial nutrition and/or hydration: Nutrition and/or liquid is given through a tube in a vein or in the stomach to supplement or replace ordinary eating and drinking. If you want your agent to have the right to withhold nutrition or hydration, it may be best to include a general statement such as "My agent knows my wishes concerning artificial nutrition and hydration."  Adding more to the general statement may unintentionally restrict your agent's authority to act in your best interest.
  • Blood transfusions: Replacing blood by giving you blood by injection.
  • Cardiopulmonary resuscitation: A group of procedures performed on a person whose heart stops beating (cardiac arrest) or who stops breathing (respiratory arrest) in an attempt to restart the heart and breathing. It can include mouth-to-mouth breathing, chest compressions to mimic the heart's function and cause the blood to circulate, drugs, electric shocks, and/or artificial breathing aimed at stimulating the heart and reviving a dying person.
  • Dialysis: Cleaning the blood by machine.
  • Major surgery: Your wishes could be stated in terms of "major surgery" or specific surgery that you do or do not want could be indicated.
  • Pain medications: Pain drugs may indirectly shorten life.
  • Respirator or other mechanical breathing device: Breathing by machine through a tube in the throat to replace the function of the lungs.

You could also state a general procedural preference tied to a projected outcome. For example, in the event of lung failure, you could decide that you want to be placed on a respirator if it is likely that you will survive it, but not if the likelihood for survival and return to a quality of life that is important to you is slim. You can also state your preference in terms of medications which treat the symptoms, rather than the disease (such as pain, blood transfusions, tube feeding or a respirator).  


When Does A Living Will Become Effective?

A Living Will goes into effect as soon as it is executed in the manner called for by state law.  It does not have to be filed officially.

The instructions for treatment only become enforceable when each of the following are present:

  • You are close to death and in a coma or coma-like condition or incoherent.
  • You cannot communicate your own wishes for your medical care: orally, in writing, or with gestures.
  • Your medical providers are aware of the existence and the terms of your Living Will.

What Do I Do With A Living Will After I Make One?

This question is common to all Advance Directives. To learn more, see: What Do I Do With My Advance Directives?.

What If I Move Or Receive Treatment In Another State?

The answer applies to all Living Wills and Healthcare Powers of Attorney (both of which are Advance Directives). To learn more, see What If I Move Or Receive Treatment In Another State?

How Often Should I Revisit My Living Will?

The answer applies to all Living Wills and Healthcare Powers of Attorney (both of which are Advance Directives). To learn more, see How Often Should I Revisit My Living Will?.

What If My Proxy's Decision Conflicts With My Living Will?

It is possible that a decision by your Healthcare Proxy about your health care will conflict with instructions in your Living Will.

Obviously such a conflict could result in a lengthy delay in any implementation of your instructions while a court resolves the conflict by trying to determine your own intent. To do that, the court will weigh the wording of the Living Will and the reasoning of the Proxy. The judge will also look to other factors which may include the desires of family and relatives, which could include people you do not wish to be part of the process.

If you give a copy of your Living Will to your Proxy, and discuss your wishes, you will minimize the chances of a conflict.

To Learn More

How Do I Assure The Provisions Of My Living Will Are Carried Out?

The mere execution of a Living Will is not enough to guarantee that your wishes will be complied with. There are simple steps you can take to assure your wishes are carried out which are described in the document in "To Learn More."