Your Living Will: Understanding the Basics

Do you have a living will? If you don't, you're not alone. Unfortunately, approximately 80 percent of Americans don't have one. Yet, drafting a living will is one of the most important actions you will ever take. It can impact your life as well as the lives of everyone you hold dear. In fact, your decisions, as reflected in your living will, may very well determine whether your life continues after a medical emergency, and if it does, with what quality of life.

Most of us are familiar with living wills as they relate to end-of-life issues. Ideally, in the face of a terminal illness, a living will as a legal document instructs medical personnel to permit us to die naturally, rather than keep us alive indefinitely through artificial means. Having a living will brings us peace of mind — we know we've put forth our wishes for our medical care, and we feel relieved that the responsibility of making difficult treatment decisions will not fall on the shoulders of our loved ones.

Terri Schiavo Case

In recent years, no case has driven home the importance of having a living will more effectively than the news-making experience of Terri Schiavo and her family. In 1990, when Terri was twenty-six years old, she suffered massive brain damage after she experienced spontaneous cardiac arrest at her home. She was later determined to be in a persistent vegetative state (PVS) with little chance of recovery. She had no living will and no durable power of attorney for health care, which meant she had not legally chosen another person to speak on her behalf if she was unable to communicate her own wishes.

Her husband, Michael Schiavo, who was Terri's guardian under Florida law, sought to remove the feeding tubes that sustained her life. Terri's parents opposed the request and sought to become her guardians. The legal battle continued for years, until 2005, when the courts decided in favor of her husband, ruling that the feeding tube should be removed. Terri Schiavo died thirteen days after the tube was removed.

The Schiavo story ignited nationwide debates over end-of-life issues, from the highest reaches of the federal government to family dinner tables. There is one certainty in this story, however. If Terri Schiavo had prepared a living will or had assigned a durable power of attorney for her health care, it would have been clear what her wishes were regarding prolonging her life through the use of a feeding tube. Her family's years of mental anguish and conflict could have been avoided.

Because of the Schiavo case, interest skyrocketed in having a living will and making it available to loved ones and medical personnel. Six weeks after Terri Schiavo's death, the U.S. Living Will Registry, which stores living wills and makes them available to hospitals on a secure Internet site, reported an increase in Web site visitors from 500 a day to 30,000 a day. Still, it's estimated that only about 59 million Americans, or 20 percent of the population, has living wills.

Definition: Living Will

A living will is a legal document in which patients are able to state in advance their desire to receive, or to withhold, life-support procedures when they are permanently unconscious or terminally ill and unable to make informed decisions. This document is a written request that life is to be or is not be prolonged by artificial means when death becomes inevitable.

Your living will tells health care workers what treatments you want and expect them to perform. It is intended to help avoid any confusion about whether you want every effort made to save your life, or whether you wish to die naturally if there is no chance of recovery.

A living will can also be called an advance directive for health care. An advance directive is simply a written statement that expresses a person's wishes in advance. The laws regarding living wills vary from state to state.

Note that your living will has no relationship to your last will and testament. Your living will has nothing to do with your property and will do nothing to distribute your property if you should die. Your living will should not create any relationships between your health care and your property, because conflicts can arise when decisions regarding your health care are combined with the disposition of personal property.

Why Have a Living Will?

A living will helps protect your right as a patient to accept or decline care. For most of us, there is one key reason for having a living will: peace of mind. Having an effective living will means you know that medical personnel will have a clear understanding about the treatment you wish to receive if you are unable to communicate. You can have additional peace of mind knowing that if you should face a life-threatening medical emergency your family will not have to go through the painful process of piecing together what they believe would be your wishes for medical treatment. This document can be especially helpful if loved ones should disagree about your course of treatment.

Does Your Living Will Express Your True Wishes?

In a perfect world, your living will would do exactly what you expect it to do if you are unable to make decisions for yourself. For example, if it's clear you cannot recover from an illness, rather than being kept alive on a ventilator for years, your living will may call for doctors to let you die.

In the real world, however, the right course of action for medical personnel may not always be so clear cut, and your living will may not express your true wishes. Let's say you have instructed in your living will that doctors let nature take its course, rather than hook you up to a ventilator for years. However, being on a ventilator only temporarily — for a few days — might be long enough for you to recover and return to your normal life. Consequently, you may not want your living will to prevent such a measure from being taken.

This is one example of why it is crucial that you clearly understand the provisions of your living will. It is possible that the document contains instructions that, if misinterpreted, could result in your being allowed to die when, in fact, you would wish to be saved. The following is an example of the best of intentions on everyone's part gone awry.

Case A

A sixty-five-year-old woman with congestive heart failure was taken to a hospital emergency room when she began having trouble breathing. Her heartbeat was irregular and her lungs had begun to fill with fluid. Shortly after being admitted to the intensive care unit, her heartbeat became dangerously irregular.

The woman had a living will. Like many living wills, it called for no heroic measures to save her life. Her biggest fear was being kept alive "artificially"...