By David Buice
A living will, despite the name, is not at all like the will you leave saying how your property should be divided when you pass on. Instead, this document lets you state your wishes for end-of-life medical care in case you are no longer able to communicate your decisions. Very importantly, a living will provides invaluable assistance to family members and medical professionals when you can no longer state your wishes. Without a living will, your family and the medical personnel treating you are left to guess what treatment a seriously ill person who can no longer speak would prefer. This uncertainty on occasion can lead to painful disputes that may lead contending parties into an argument—or courtroom.
Preparing a Living Will
In Texas a living will is known officially as a Directive to Physicians and Family or Surrogates. You may wish to have legal assistance in preparing this form. You can fill out the form yourself, but it must be signed by two witnesses verifying its authenticity. A copy of the form can be found on the Texas Health and Human Services website at HHS.Texas.gov.
Things to Consider
In determining the wishes you’d like to be expressed in your living will, think about your core values. For example, how important is it for you to be independent and self-sufficient, and what do you feel would make your life not worth living? Do you want treatment to extend your life in any situation, or would you want treatment only if there is a possible cure?
Before making any final decisions you should discuss these questions with your primary care doctor as well as family and friends. There are several specific issues you should address.
- Resuscitation restarts the heart when it has stopped beating. Determine if and when you want to be resuscitated by cardiopulmonary resuscitation (CPR) or by a device delivering an electric shock to stimulate the heart.
- Mechanical ventilation takes over your breathing when 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 your body with nutrients and fluids either intravenously or via a tube to the stomach. Decide if you want to be fed this way and for how long.
- Dialysis removes waste from your body if your kidneys no longer function. Do you want this treatment and for how long?
- Antibiotics or antiviral medications are used to treat many infections. If near the end of your life, do you want infections treated aggressively or would you prefer the infections run their course?
- Comfort (palliative) care includes interventions that may be used to keep you comfortable and manage pain, while still respecting your wishes. These considerations include being allowed to die at home, getting pain medications, being fed ice chips to soothe dryness and avoiding invasive tests or procedures.
- Organ and tissue donations can also be covered in your living will. If you agree to organ donations, you will be kept on life-sustaining treatment until the procedure is completed, and you may want to state in your living will that you understand the need for this intervention.
Medical Power of Attorney
Alongside preparing a living will, you should consider designating someone to make decisions on your behalf when you are unable. This person whom you choose to carry out your end-of-life wishes is known as the health care agent, proxy, surrogate, attorney-in-fact or patient advocate. In making your choice, designate someone who can be trusted to make decisions that adhere to your wishes and values. You can also get a Medical Power of Attorney Form at the Texas Health and Human Services website. (HHS.Texas.gov)
Advance Directives: Frequently Asked Questions
In addition to your living will and medical power of attorney, Texas recognizes other advance directives related to end-of-life issues. These include the Out-of-Hospital Do-Not Resuscitate Order (DNR) and the Declaration for Mental Health Treatment. Again, copies of these can also be found at the Texas Health and Human Services website (https://hhs.texas.gov/laws-regulations/forms/advance-directives).
To alleviate any concerns you might have about these advanced directives, let’s answer some frequently asked questions about these documents.
What happens to living wills after death?
Any authority granted by a living will ends when the person who made the document dies. One exception that some living wills and powers of attorney make is that giving healthcare professionals the authority to make decisions about organ or tissue donations. But because those decisions must be made soon after death, this authority does not last long.
Where should I keep my advance directives?
You should keep the original copies of your advance directives and give a copy to your regular doctor. Give a copy of your living will and medical power of attorney to the person you have chosen as your agent and keep a record of everyone who has a copy.
Can I change an advance directive?
Yes, you can change or cancel an advance directive at any time. If you wish to cancel an advance directive while in the hospital, tell your doctor, family members, your agent and any others who need to know.
Do I have to have advance directives?
No, you do not. No one may deny you medical care or insurance coverage if you have not prepared advance directives. Completing advance directives is not a required part of patient registration in a hospital, nursing home or other healthcare facility.
What if I don’t have advance directives?
If you have not signed any advance directives and you become ill and cannot express your wishes, your attending physician and certain family members can make decisions about your care.
To avoid uncertainties and confusion at a critical time in your life, at a minimum you should prepare a living will and a medical power of attorney.
Preparing a living will and designating a medical power of attorney will not, of course, alleviate the sadness and sense of loss felt by your family and friends with your passing. But with some consideration and advanced planning on your part, hopefully you can assuage any sense of guilt on their part by making your end-of-life wishes clearly known.
