living will


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Related to living will: living trust, Durable power of attorney

Living Will

A written document that allows a patient to give explicit instructions about medical treatment to be administered when the patient is terminally ill or permanently unconscious; also called an advance directive.

With improvements in modern medicine, the life of persons who are terminally ill or permanently unconscious can be prolonged. For increasing numbers of persons, the decision of whether to prolong life is being made in the form of a written document called a living will. The living will is one type of advance directive that may be used by a person before incapacitation to outline a full range of treatment preferences or, most often, to reject treatment.

A living will extends the principle of consent, whereby patients must agree to any medical intervention before doctors can proceed. It allows the patient to guide health care for the future when she may be too ill to make decisions concerning care. It can be revoked by the patient at any time. For many the living will preserves personal control and eases the decision-making burden of a family.

Forty-two states and the District of Columbia have living-will statutes that make a properly executed living will legally binding. In states that do not have a statute, living wills stand as a clear expression of the patient's wishes. Living-will statutes require that the person be legally competent to execute the will and that the will be witnessed by at least one disinterested person. Once a person who has a valid living will is terminally ill, the attending physician and a second physician must certify in writing that there is no reasonable expectation for improvement in the patient's condition and that death will occur as a result of the incurable disease, illness, or injury.

Upon this certification the doctor is obligated to follow the instructions contained in the living will. This typically means the patient does not want any medical procedures that serve only to prolong but not prevent the dying process. Therefore, if the patient is unable to breathe, the doctor is not required to connect the patient to a respirator. A patient may state in a living will that he does not want a feeding tube if unable to swallow food. Another common directive is to forbid resuscitation if the patient's heart stops beating.

Living wills have been criticized because they are usually limited to the withholding or withdrawing of "life-sustaining" procedures from a patient with a "terminal condition" or "terminal illness," and thus do not accurately reflect the broad legal right to refuse treatment. In addition, by their very nature, living wills reduce the patient's wishes to writing, and thus may be too rigid (or too vague) to adapt to changing interests or anticipate future circumstances.

To overcome these problems, many states have enacted statutes that permit a competent adult to designate a surrogate decision maker (also termed a health care proxy or agent) to make health care decisions for her in the event of incapacitation. The proxy's authority is usually not limited to decisions about life-sustaining treatment. A proxy can supplement a living will.

All fifty states have durable-power-of-attorney statutes that permit an individual (the principal) to designate another person (the attorney in fact) to perform specific tasks during any period of incapacity. Though most of these statutes do not expressly refer to medical care decisions, no court has ruled that they preclude the delegation of medical decision-making authority to the attorney in fact.

Cross-references

Death and Dying; Health Care Law; Organ Donation Law; Patients' Rights; Physicians and Surgeons; Quinlan, In re.

living will

n. also called "a durable power of attorney," it is a document authorized by statutes in all states, in which a person appoints someone as his/her proxy or representative to make decisions on maintaining extraordinary life-support if the person becomes too ill, is in a coma or is certain to die. In most states the basic language has been developed by medical associations or other experts and may provide various choices as to when such maintenance of life can be terminated. The decision must be made in consultation with the patient's doctor. The living will permits a terminal patient to die in dignity and protects the physician or hospital from liability for withdrawing or limiting life support.

living will

see ADVANCE DIRECTIVE.
References in periodicals archive ?
Living wills also don't account for the fact that people's wishes may change over time, said Dr.
One of the many measures in the Act was the creation of a new tool--known as resolution plans, or "living wills"--aimed at helping policymakers work toward the objective of making the largest and most complex financial institutions resolvable without public assistance if they become financially distressed.
You may want to consider including a do not resuscitate order (DNR) as part of your living will, since a living will alone does little to protect you from unwanted emergency care, such as cardiopulmonary resuscitation (CPR).
Participants were asked to review two different living will formats, a commonly available West Virginia living will and the proposed version.
Significant differences by nursing field were observed in knowledge about the need to formalise the living will before a notary (p<0.001), whether the LWD is regulated by law in Spain (p=0.004), the need to assign a delegate person (p=0.032), and the need to be enrolled in the registry of the Department of Health (p=0.011).
The rules for crafting the living wills are 74 pages long, including an explanatory supplement.
Dr Miriam says: Although there's no law that governs the use of living wills, in common law, refusing treatment before you need it will have a legal effect as long as it meets the following conditions:
(87) Commenters believed the short time frame would prove inadequate, and some observers recommended that regulators extend the deadline for initial living will submissions up to eighteen months after rule enactment.
This section will consider an ethical analysis of the living will according to the first and second formulation of Kant's Categorical Imperative.
Nationwide, a Pew Research Center survey conducted last November found that while public awareness of living wills is now "virtually universal," only 29 percent of adults actually have completed one.
Then came the movement for living wills and other advanced directives that allow people to specify their wishes about end-of-life care while they are competent to express them.