Living Will

GENERAL INFORMATION:

What is a Living Will? A living will is a written record of the care you would choose for yourself during terminal injury or illness. A terminal illness or injury is one that will cause you to die within the near future. It is called a "living will" because it is used while you are still alive, but your death is very near. Your living will usually describes what kind of care you do or do not want. A few states do not require caregivers to follow the instructions in a living will. But even in those states, a living will may be an important way to help your family and caregivers better know your exact wishes. Talk with your family and caregivers after you have finished your living will. Also, make sure your family and caregivers have a copy of your living will.

When does a living will go into effect?

• Some states control when a living will can take effect (start). Others states may let you make the decision. Most states require that 1 or 2 doctors must decide that you have an injury or illness that cannot be cured and that will cause you to die. Also, you must be unable to make decisions or tell others what you have decided. This means like being in a coma, or unconscious.
  
  
• Before the living will can start, you need to be in a coma or unconscious for some time. Usually this is at least a week, or longer. Sometimes you may be able to decide what that amount of time is. But, there may be a certain length of time your state requires before the living will can take effect.

What are some of the things I will need to think about? You need to think about the following questions when deciding if you want to have a living will.

• Do I want to have my life made longer by medical treatments or procedures? People who sign living wills usually do not want treatments or procedures to make their lives last longer. You sign a living will to tell caregivers you want treatments or procedures stopped, or not given at all. You may also sign a living will to limit types of treatments and care that may not help you. This does not mean that if you refuse life-supporting care that you will not receive any care at all. You will still be given palliative (pah-lee-uh-tiv) care. This is also called comfort care that keeps you pain-free and comfortable.
  
  
• Do I want to have food and liquids given to me through a tube or an IV? The form may have a place that asks what you want done about food, liquids, and other treatments. If you are being given food and liquid through a tube or an IV, you may be able to decide when to stop them. You may be able to decide that they should be stopped right away, or that they should continue for a certain time period. You may also decide that they should be continued for as long as you are alive.
  
  
• Are there any special limits I want on when care will or will not be given, or what type of care will be given?
  
  
  • The form you fill out may have a place for you to tell caregivers about any limits on health decisions. You may be able to choose certain conditions where you do not want to have procedures and treatments to make your life longer. This may include length of time to any care that you have said you do, or do not want. For example, you may choose to have all treatments and care while you are in a long-term coma. But, you may also be able to write that "if I am still in a coma after 6 months, I want all care including food and fluids to stop."
    
    
  • You may be able to include your wishes about organ and tissue donation in the form. And, you may write your beliefs about how long you want to live (quantity of life), and how you want to live (quality of life). You may also include your views on health, being independent and in control.
  
  
• Ask caregivers questions about anything you do not understand. Make sure you fully understand treatments or care you may receive before you write down your wishes.
  
  
• Plan your living will when you are not upset , or having an emergency medical problem.
  
  
• Look at the benefits and burdens (problems) that each of your decisions may cause for you and your family.
  
  
• The following may help you to write down your thoughts and beliefs about certain medical situations. Your ideas about each of these may help your family and caregivers to better understand your wishes.
  
  
  • Medical procedures you may need, or that you have liked or disliked.
    
    
  • What you think about organ and tissue donation.
    
    
  • Your views on health, being independent, and in control.
    
    
  • Your beliefs about religion, God, and heaven.
    
    
  • Your beliefs about quality of life (how you want to live) and quantity of life (how long you want to live).
  
  
• Think about the following 4 situations when you make decisions about what you want medically.
  
  
  • What if I am in a coma and I have no possible chance of waking up from it?
    
    
  • What if I am in a coma where I might wake up and be OK?
    
    
  • What if I have brain damage?
    
    
  • What if I have brain damage and a terminal illness (sickness that causes death)?
  
  
• Then think about the treatments below that might be offered in each of these situations above.
  
  
  • Antibiotics.
    
    
  • Blood transfusions (trans-few-shun).
    
    
  • Chemotherapy (cancer fighting medicine).
    
    
  • CPR. (re-starting your heart and breathing when it stops)
    
    
  • Invasive (in-vah-siv) tests (tests that are uncomfortable or cause pain).
    
    
  • Surgery.
    
    
  • Tubes or IV's to give you food or fluids.
    
    
  • Ventilator (machine that breathes for you).
  
  
• This is where you choose what you want for care. Pick 1 of the following choices for the above possible treatments for short-term or long-term brain damage or coma.
  
  
  • I would want it.
    
    
  • I want the treatment tried; but if I do not clearly get better, then stop it.
    
    
  • I do not know if I want it.
    
    
  • I do not want it.

Do I need someone to watch me sign my living will?

• Most states will require you to have people watch you sign your living will. And, then they will also sign to say that they were witnesses. Often, a state will not allow someone to be a witness if the person is your doctor. A person also cannot be a witness if you owe money to them. Or, if they will inherit money or property from you when you die.
  
  
• Some states may want you to have a special kind of witness called a notary public. A notary public has a special place according to state law as an "official" witness. He will use a special stamp on the form to show that he saw you sign it. It is very important that you follow your state's rules about witnesses exactly. If you do not follow state rules, the living will may not be legal and your wishes may not happen.

Where can I get more information about living wills? The information in this handout is not legal advice. Each state has a special form for a legal living will. The state where you live may require more or less information in your living will. Some states may not allow caregivers to follow the terms of a living will. Talk to one of the following people or groups to get more help on what you need to do in your state to fill out a living will.

• Your caregiver or doctor.
  
  
• Hospitals, hospices, home healthcare agencies and long-term care facilities (nursing homes).
  
  
• Your state attorney general's office.
  
  
• Your lawyer.

• Partnership for Caring, Inc.
  America's Voices for the Dying
  Partnership for Caring, Inc.
  1620 Eye Street NW, Suite 202
  Washington , DC 20007
  Phone: 1-800-989-9455
  Web Address: http://www.partnershipforcaring.org
  

• Legal Services for the Elderly
  130 West 42nd Street
  New York, NY 10036
  Phone: 1-212-391-0120
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about living wills and how they are used. You can then discuss treatment options with your caregivers. Work with them to decide what care will be used to treat you. You always have the right to refuse treatment.

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