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Advance directives are legal documents prepared in order to express the health care wishes of a patient who may be unable to speak directly with health care personnel due to health issues. This document could have a variety of different titles, including Living Will, Do Not Resuscitate Order (DNR) or even Health Care Proxy or Power of Attorney. The latter two documents can simply be used to name the individual who is responsible to make health care decisions for a patient who is unable to communicate, but can also include the patient’s wishes in an end of life scenario.

This advance directive would be put into play in a situation where a patient is unable to make and express their own medical decisions. That the patient is indeed in such a state must be certified by more than one physician. As state laws vary, other requirements may exist and different terminology may be used in the documents. Generally, the medical condition must be certified as “terminal illness” or “permanent unconsciousness” in order for an advance directive to be put into use. Further, should the patient again become able to make their own health care decisions, the agent’s authority under the advance directive would end.

One situation in which an advance directive would not be applicable is in the care of emergency personnel who may be called to the scene of an accident. In such a case, the emergency personnel are obligated to stabilize a patient’s condition and transfer them to the appropriate health care facility for further treatment. At that point, once a patient’s situation has been evaluated by a medical doctor, an advance directive may be put into use.

While advance directives, under a variety of terms, are valid throughout the United States, as stated previously, state laws vary and not all states will acknowledge a directive drafted under another state’s laws. Therefore, anyone who maintains a residence in more than one state, or who may work or travel often to another state, should prepare a directive in each state according to each state’s laws, in order to protect themselves properly.

Only completion of a new advance directive will invalidate the old directive, as these directives do not expire. Nevertheless, advance directive should be reviewed periodically to determine if they still reflect the wishes of the patient. If you wish to make even one change in the directive, it is advisable to prepare a completely new document.

Special Sources To Note:

Understanding Your Living Will (Addicus Books, 2006) http://www.addicusbooks.com/show_title.cfm?isbn=1886039771  

Mirarchi,Ferdinando Does a Living Will Equal a DNR? Is Patient Safety Compromised?, Journal of Emergency Medicine, Vol. 33, No.3, pp299-305, 2007.
http://www.jem-journal.com/article/S0736-4679(07)00161-8/abstract

Mirarchi, Ferdinando L “Living Wills & DNR: Is Patient Safety Compromised?”. Human Life Review. . FindArticles.com. 23 Sep. 2008. http://findarticles.com/p/articles/mi_qa3798/is_200710/ai_n24394969

More and more people are preparing living wills and DNR (do not resuscitate) orders, both of which are created to assist patients in the event of a medical emergency if they are unable to speak for themselves. You should be aware that laws and rules regarding preparation of these and other documents pertaining to health care issues vary from state to state, so it is wise to consult an attorney and your health care provider prior to preparing and/or signing anything.

A living will is a document that you can prepare on your own or with the assistance of an attorney or health care professional. This document lists the medical treatment you wish in the event that you are in terminally ill or are in a permanently unconscious state and cannot communicate with your health care provider, and can also name an individual to act in your stead to ensure that your wishes are carried out.

A DNR order is actually prepared by a physician based upon the patient’s current health situation, the physician’s advice and information provided regarding the patient’s wishes. The DNR order tells health care providers whether they should attempt to resuscitate a patient if it should be necessary during a medical procedure or as a result of a terminal illness.

Dr. Ferdinando L Mirarchi has suggested that one problem with a living will is a lack of individualization, as these documents are generally prepared from a standard template, when an individual is also preparing other legal documents, such as their Last Will and Testament or Power of Attorney. Because the living will is more often prepared only on the advice of an attorney, it may not contain language that is conducive to assisting health care providers in determining a patient’s exact wishes. This is because they are prepared without informed consent, meaning the patient has not consulted with a physician regarding specific issues connected with their medical treatment and they may not understand all the risk and/or benefits involved with their treatment. Also, a living will can be prepared years prior to being used and, therefore, may no longer be relevant when needed.

Additionally, a patient entering the hospital without a living will, often prepares and signs a generic document, at the direction of hospital personnel, but once again, this is without informed consent and may not meet the needs of the patient and their care. Add to that the fact that most patients aren’t even really sure what they are signing, and you can see that these documents can often be misinterpreted or not adhere to the patient’s wishes.

Another issue that can arise is that many health care professionals may interpret certain terms to mean different things, especially since the language in the documents can be ambiguous. Finally, in some cases, having a living will can be interpreted as having a DNR order, when the two documents do not necessarily cover the same issues. Beyond that, some medical professionals may interpret the phrase “do not resuscitate” to mean “do not treat” when the patient may not mean that at all. A patient may not wish to be resuscitated if they are nearing death and their heart and/or breathing has stopped. However, a desire by a patient to not be kept alive in a vegetative state, is not necessarily the same thing as not wishing to have treatment that can save their life.

Special Sources To Note:

Understanding Your Living Will (Addicus Books, 2006)http://www.addicusbooks.com/show_title.cfm?isbn=1886039771

Mirarchi,Ferdinando Does a Living Will Equal a DNR? Is Patient Safety Compromised?, Journal of Emergency Medicine, Vol. 33, No.3, pp299-305, 2007.
http://www.jem-journal.com/article/S0736-4679(07)00161-8/abstract

Mirarchi, Ferdinando L “Living Wills & DNR: Is Patient Safety Compromised?”. Human Life Review. . FindArticles.com. 23 Sep. 2008. http://findarticles.com/p/articles/mi_qa3798/is_200710/ai_n24394969

Although more and more, people are preparing Living Wills or other advance health care directives, these documents may not live up to what we expect of them. Differences in state laws and miscommunication between attorneys, patients and their health care providers can cause the documents to have little or no meaning when an end of life situation occurs.

Also, physicians may ignore an advanced directive, simply because they do not believe it adequately reflects the patient’s wishes or because they do not understand what is desired by the patient. Misinterpretation of the directive could be due to the use of legalese rather than actual medical codes, which codes would make more sense to health care personnel in a medical situation. Some physicians may mistakenly believe living will or other advance directive is the same as a DNR (do not resuscitate) code order.

Code orders have specific meaning for health care personnel, and although they can be interpreted differently, they can also help to clarify the patient’s wishes, when discussed with their doctor. There are several codes: full code, which means that the medical personnel should do everything necessary to keep a patient alive; hospice care/comfort care, indicates that nature should be allowed to take its course, and while medical personnel should make the patient comfortable and relieve pain, the patient should be allowed to die naturally; slow code, applies when a patient will not benefit from further medical care, and once again medical personnel will provide comfort, until the patient dies; no code/DNR, are similar, although there can be confusion in a no code situation, but they are generally meant to imply that health care personnel are not to attempt to resuscitate a patient who is near death and whose heart or breathing have stopped; chemical code, this implies that the patient wishes only to have medication administered, but to have no invasive procedures performed; and DNI, which stands for do not intubate.

As can be seen, there can still be some confusion among these codes. Therefore, prior to the completion of a living will, it is wise for the patient to discuss all these options with their physician. The patient should fully understand what the choices they have made mean, and also when these choices may be used in a health care situation. The document itself should outline the parameters for its enactment in the case of medical emergency.

Once a patient has provided their physician with an advance directive, they may also prepare a POLST (Physician Orders for Life Sustaining Treatment). This document should be used in conjunction with an advance directive. Again, this should be fully discussed with the physician, and its effectiveness can depend upon the understanding of all the health care personnel who are treating the patient.

Ideally, the advance directive, in order to be as effective as possible, should include all of the following: primary information, pertinent medical information, a resuscitation choice, a do not transfer order, and a hold harmless statement. Further, the document should be portable, follow all state laws, and require the confirmation of a second physician in a case of a terminal condition or persistent vegetative state. It is also wise for the patient to choose “safe” codes, such as full code or hospice/comfort care, rather than other codes which can be misinterpreted.

Obviously, as these documents are so open to confusion, it is best to make sure that the patient’s wishes are effectively communicated to the physician, other health care personnel and any proxy appointed by the patient, prior to the document’s enactment.

Special Sources To Note:

Understanding Your Living Will (Addicus Books, 2006) http://www.addicusbooks.com/show_title.cfm?isbn=1886039771

Mirarchi,Ferdinando Does a Living Will Equal a DNR? Is Patient Safety Compromised?, Journal of Emergency Medicine, Vol. 33, No.3, pp299-305, 2007.
http://www.jem-journal.com/article/S0736-4679(07)00161-8/abstract

Mirarchi, Ferdinando L “Living Wills & DNR: Is Patient Safety Compromised?”. Human Life Review. . FindArticles.com. 23 Sep. 2008. http://findarticles.com/p/articles/mi_qa3798/is_200710/ai_n24394969

More and more people are preparing living wills and DNR (do not resuscitate) orders, both of which are created to assist patients in the event of a medical emergency if they are unable to speak for themselves. You should be aware that laws and rules regarding preparation of these and other documents pertaining to health care issues vary from state to state, so it is wise to consult an attorney and your health care provider prior to preparing and/or signing anything.

A living will is a document that you can prepare on your own or with the assistance of an attorney or health care professional. This document lists the medical treatment you wish in the event that you are in a permanently unconscious state and cannot communicate with your health care provider, and can also name an individual to act in your stead to ensure that your wishes are carried out.

A DNR order is actually prepared by a physician based upon the patient’s current health situation, the physician’s advice and information provided regarding the patient’s wishes. The DNR order tells health care providers whether they should attempt to resuscitate a patient if it should be necessary during a medical procedure or as a result of a terminal illness.

One problem with a living will is a lack of individualization, as these documents are generally prepared from a standard template, when an individual is also preparing other legal documents, such as their Last Will and Testament or Power of Attorney. Because the living will is more often prepared only on the advice of an attorney, it may not contain language that is conducive to assisting health care providers in determining a patient’s exact wishes. This is because they are prepared without informed consent, meaning the patient has not consulted with a physician regarding specific issues connected with their medical treatment and they may not understand all the risk and/or benefits involved with their treatment. Also, a living will can be prepared years prior to being used and, therefore, may no longer be relevant when needed.

Additionally, a patient entering the hospital without a living will, often prepares and signs a generic document, at the direction of hospital personnel, but once again, this is without informed consent and may not meet the needs of the patient and their care. Add to that the fact that most patients aren’t even really sure what they are signing, and you can see that these documents can often be misinterpreted or not adhere to the patient’s wishes.

Another issue that can arise is that many health care professionals may interpret certain terms to mean different things, especially since the language in the documents can be ambiguous. Finally, in some cases, having a living will can be interpreted as having a DNR order, when the two documents do not necessarily cover the same issues. Beyond that, some medical professionals may interpret the phrase “do not resuscitate” to mean “do not treat” when the patient may not mean that at all. A patient may not wish to be resuscitated if they are nearing death and their heart and/or breathing has stopped. However, a desire by a patient to not be kept alive in a vegetative state, is not necessarily the same thing as not wishing to have treatment that can save their life.

Wills and Trusts are important for every person to know about. Before beginning a will or a trust, you should know the difference between them and how they are beneficial to you. Depending on your circumstances, one may suit you better than the other.

A trust allows you to be the grantor who manages your trust assets during your lifetime. Trusts also allow provisions to be made for a successor trustee to take charge in your place. A living trust is a very popular choice. A trust doesn’t need to go through probate proceedings. It helps you save costs when dealing with out-of-state property. There’s not an automatic court supervisor that will deal with any disputes over the trust. When you pass away, the trust stays private. There are more costs to prepare, manage, and fund a trust than it does to prepare a will.

A will is a legal document allowing you to distribute your property to the people of your choice. Wills also allow you to designate beneficiaries who will receive specific items that you want them to have. A will is always subject to probate proceedings. It does fall into the out-of-state property proceedings within that state. They provide court supervision for handling beneficiary issues, as well as creditor disputes. At the time of your death, your will becomes public record. There are some taxes that are put upon a will, but these taxes are put on trusts as well. Most people pay a lawyer to help draw up a will. Wills main cost is to have them probated. When dealing with a will, you must have an executer, a person who makes sure that what you want done is being done.

A will, therefore, comes into effect after you pass away. A living trust begins once you have established it. A living trust benefits you while you are alive. If you have a living trust, you must make a “Pour-over Will” at the same time. This will pour-over all the assets from your trust into the will you drew up when you pass away. Trusts help to keep track of your property before and after you pass away. If, by chance, you are unable to keep track of your trust, it is placed in the care of a successor trustee. There are also joint living trusts. These trusts incorporate both the husband and the wife’s assets into one specific trust, instead of two.

Be sure not to get a will and a living will confused. While a will states where you want your property and items to go; a living will defines your beliefs and wishes about your health such as being kept alive on artificial life support, or not.
A trust and a will are two very important documents to consider when helping save your family and loved ones the pain of dealing with costs and fighting. In both trusts and wills, you need to be extremely specific on the items you have and where you want them to go.

A living will is one of the two types of advance health directives available. A living will usually covers your directives as to what treatment you want, or don’t want, if you are ill and unable to give informed consent due to incapacity from the illness. Your living will is most often accompanied by a power of attorney or a health care proxy. The power of attorney portion of your living will names another person to make the decisions for your health and treatment if you are incapacitated and unable to do so.

There are many reasons why you should have a living will. In this modern technological age, doctors can do a variety of treatments, some even experimental, to help treat illnesses. Incapacitating illness can happen to anyone in the blink of an eye. There is no real way to be prepared for incapacitation, except to ensure that there is documentation about how your want your medical treatment to go should you not be able to answer for yourself. This is where a living will comes in.

If you are in a coma, on life support or otherwise incapacitated and unable to speak or answer questions, your living will does the speaking for you. It tells your family, loved ones and the doctors what you want and don’t want for treatment. There are many people who do not want to be put on life support at all and many families would have a difficult time making that decision should it come to that. Your living will answers those difficult questions, leaving the decision up to you and taking it off the shoulders of your family.

On the flip side of that coin, there are people who want every possible measure taken to ensure that all has been done – unending scopes of treatments and further into experimental treatments if necessary. Some families would see that pain and suffering and want to end it mercifully by not allowing the doctors to continue with treatment.

If you know what you want to have done, should you become incapacitated by an illness or accident, then you should have a living will drawn up. This lets your wishes be known to everyone and many families are opting for them now. It takes the ‘hard decisions’ off the shoulders of the families and does what you want with your life and body leaving them without guilt or remorse, or questioning what should be done.

Living wills are not difficult to draft, and should be accompanied with conversations with your loved ones and your physical. Don’t let your wishes only be known if there is an incapacitating illness for you. They can be done without the help of a lawyer or attorney, although it is highly suggested that you speak with your loved ones about your personal healthcare directive when you are completing it, so that they can comprehend your wishes.

It is an important decision to make to have a living will and naming a health care agent with your living will is also a very important decision to make. Your living will states what life supporting measures you want to have taken, if any, should you become terminally ill or incapacitated and unable to speak and answer questions for yourself. A health care agent is named in your living will to act on your living will’s directives for your health care.

Choosing someone to be your health care agent is a very large decision. You should discuss your wishes at great length with the person you have chosen. The person you choose should know your wishes and be comfortable with them. By talking to the person you choose as your health care agent, you will help them to understand your choices and decisions about your end of life care. It is obviously important to ensure that the person you choose as your health care agent is willing and able to carry out the wishes as stated in your living will.

While talking to the person who is appointed as your health care agent is important, it is also important that you talk to your physician, attorney, clergy and family about the choices in your living will as well. It would be more difficult for them to find out that you chose to have no life sustaining measures taken when you were already ill and incapacitated.

There are many people that you can choose to be your health care agent, however you are NOT allowed to name any of the following people as your health care agent:

– Your doctor
– A treating health care provider
– A non-relative employee of a hospital, your doctor or other health care provider who is treating you.
– An operator of a nursing home.
– Operator of an assisted living facility or community care facility
– A non-relative employee of a nursing home, assisted living facility or community care facility.

Your living will and your health care agent only take over in authority when you are unable to make your own decisions, such as being in a coma, having been diagnosed with a terminal illness that has rendered you mentally or physically completely incapacitated or other incapacitation in which you can not be held liable for answering questions directly relating to your treatment or health.

The person that you choose as your health care agent should be someone that you trust and know well, and that in turn knows you well. Discussions should be held in private when you ask the person to be your health care agent, should you become incapacitated. Allow them an open floor to ask any questions that they have regarding your decisions.

What is a living will?A living will is a document that declares your choices for end of life care, should you become terminally ill or incapacitated and unable to speak for yourself. 

 When does a living will come into effect?

A living will comes into effect when two doctors certify that you have an incurable illness and are terminal, or you are permanently unconscious or in a vegetative state.  

Will paramedics withhold treatment based on a living will?

No, a living will isn’t self-activating and only takes effect when two doctors certify that you are terminal and death is imminent. When those conditions are met, a ‘do not resuscitate’, or DNR, order is issued by your doctor. If you have a DNR, then paramedics will abide by that order.  

When can I have a living will?

You can have a living will if you are over the age of 18, of sound mind, and acting on your own free will.  

Is a living will apart of an ordinary will?

No, a living will specifies your healthcare wishes while an ordinary will deals with your property and estate.  

What are the life support choices I have with my living will?

There are three options for your living will and life support choices:

Have the doctors to everything that they can to keep you alive.

• Only life-sustaining measurements that you allow are to have an artificial feeding tube for nutrition and hydration.
• No life sustaining treatment, including nutrition and hydration.

However, regardless of which of the three options listed above that you choose, you will be provided with pain medication to keep you comfortable.

What happens if I am pregnant when I become incapacitated?

All life sustaining measures will continue if you are pregnant, regardless of any directives in your living will.  

Can I change my mind about the choices in my living will?

Yes, you can, you can always create a new living will and revoke or terminate your existing living will, even without creating a new one.

Who can I appoint as my healthcare agent?

Your healthcare agent should be someone you trust and that can handle the directives in your living will. There are many people that you can choose to be your health care agent, however you are NOT allowed to name any of the following people as your health care agent:

• Your doctor
• A treating health care provider
• A non-relative employee of a hospital, your doctor or other health care provider who is treating you.
• An operator of a nursing home.
• Operator of an assisted living facility or community care facility
• A non-relative employee of a nursing home, assisted living facility or community care facility.

Do I need a lawyer to do a living will?

No, you can do your living will on your own and it does not even need to be notarized or witnessed, however having a lawyer is always a good idea for such important papers.

There is a lot of confusion about living wills and whether or not you require an attorney to draft and sign a living will. The most basic answer of whether or not you need a lawyer to draft your living will is no, you do not.

You do not need to have a lawyer oversee the documentation of your living will however; you can hire a lawyer to help you draft the living will. Living wills are not required to be witnessed in order to be valid. You also do not need to have your signature notarized or witnessed in order for the living will to be valid in some states. However, a living will document is a very important one and it is always a good idea to have your signature notarized on any important documents, or to have them drawn up by an attorney.

It is always advisable to have a lawyer draft any important document that you need, such as a living will. A living will is very important and has ramifications to your end of life care. It’s best to discuss your wishes with other people, primarily your family and friends, your physician, your clergy or priest and your lawyer. By having many people know what your end of life wishes are, that are stated in your living will, they are more likely to feel comfortable with the decisions you have made and put in writing for them to follow, should something happen to you.

If you already had a living will before new legislation moved in, lowering the requirements for living wills to be valid, check with your lawyer if your current living will is still valid or if it needs to be redone. A few years ago, living wills were required to be witnessed and notarized and drawn up by a lawyer, however, those rules have relaxed quite a bit.

There are web pages online that offer templates for a living will that you can simply fill out and print off of your computer. However, while it is that simple to draft a living will, you should give it some serious thought and discussions with the people who are close to you. There are three basic life support choices that you have with a living will:

Have the doctors to everything that they can to keep you alive.
Only life-sustaining measurements that you allow are to have an artificial feeding tube for nutrition and hydration.
No life sustaining treatment, including nutrition and hydration.
However, regardless of which of the three options listed above that you choose, you will be provided with pain medication to keep you comfortable.

If you happen to be pregnant when you become incapacitated, you will be kept alive using all means necessary, regardless of what your living will states, until the birth of the baby, at which point, your living will would kick in and become activated with your choices.