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Living wills and advance directives for medical decisions

Living wills are one part of advance directives and describe your treatment preferences in end-of-life situations. Unexpected end-of-life situations can happen at any age, so all adults need advance directives.

By Mayo Clinic staff

Living wills and other advance directives describe your preferences regarding treatment if you're faced with a serious accident or illness. These legal documents speak for you when you're not able to speak for yourself — for instance, if you're in a coma.

Living wills and other advance directives aren't just for older adults. Unexpected end-of-life situations can happen at any age, so it's important for all adults to have advance directives.

Advance directives: More than just living wills

Advance directives are written instructions regarding your medical care preferences. Your family and doctors will consult your advance directives if you're unable to make your own health care decisions. Having written instructions can help reduce confusion or disagreement. Anyone age 18 or older may prepare advance directives.

Advance directives include:

  • Living will. This written, legal document spells out the types of medical treatments and life-sustaining measures you do and don't want, such as mechanical breathing (respiration and ventilation), tube feeding or resuscitation. In some states, living wills may be called health care declarations or health care directives.
  • Medical power of attorney (POA). The medical POA is a legal document that designates an individual — referred to as your health care agent or proxy — to make medical decisions for you in the event that you're unable to do so. A medical POA is sometimes called a durable power of attorney for health care. However, it is different from a power of attorney authorizing someone to make financial transactions for you.
  • Do not resuscitate (DNR) order. This is a request to not have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Advance directives do not have to include a DNR order, and you don't have to have an advance directive to have a DNR order. Your doctor can put a DNR order in your medical chart.

How to plan for end-of-life issues

Injury, illness and death aren't easy subjects to talk about, but by planning ahead you can ensure that you receive the type of medical care you want, to take the burden off your family of trying to guess at what you'd want done. Start by having a conversation with your loved ones. Let them know you're creating advance directives and explain your feelings about medical care and what you'd want done in specific instances.

If you want to encourage parents or other family members to create advance directives, explain that it's important for you and the family to know how they would want to be treated. It's generally best to approach the subject in a matter-of-fact and reassuring manner.

Keep in mind that a living will cannot cover every possible situation. Therefore, you may also want a medical POA to designate someone to be your health care agent. This person will be guided by your living will but has the authority to interpret your wishes in situations that aren't described in your living will. A medical POA may also be a good idea if your family is opposed to some of your wishes or is divided about them.

Choosing a health care agent

Choosing a person to act as your health care agent is possibly the most important part of your planning. You need to trust that this person has your interests at heart, understands your wishes and will act accordingly. He or she should also be mature and levelheaded, and comfortable with candid conversations. Don't pick someone out of feelings of guilt or obligation.

Your health care agent doesn't necessarily have to be a family member. You may want your health care decision maker be different from the person you choose to handle your financial matters. It may be helpful, but it's not necessary, if the person lives in the same city or state as you do.

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References
  1. Litin SC, ed. Mayo Clinic Family Health Book.3rd ed.. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2003:141.
  2. Crane MK, et al. Respecting end-of-life treatment preferences. American Family Physician. 2005;72:1263. http://www.aafp.org/afp/20051001/1263.html. Accessed June 11, 2009.
  3. What are advance directives? National Hospice and Palliative Care Organization. http://www.caringinfo.org/PlanningAhead/AdvanceDirectives/WhatAreAdvanceDirectives.htm. Accessed June 11, 2009.
  4. Preparing your advance directives. National Hospice and Palliative Care Organization. http://www.caringinfo.org/PlanningAhead/AdvanceDirectives/WritingYourAdvanceDirectives.htm. Accessed June 11, 2009.
  5. Creagan ET (expert opinion). Mayo Clinic, Rochester, Minn., June 11, 2009.
  6. Takahashi PY (expert opinion). Mayo Clinic, Rochester, Minn., June 11, 2009.
  7. What to do if family members disagree. National Hospice and Palliative Care Organization. http://www.caringinfo.org/PlanningAhead/AdvanceCarePlanning/WhatToDoIfFamilyMembersDisagree.htm. Accessed June 11, 2009.

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July 11, 2009

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