Close-Up: Living Wills

Physician's Money Digest, June30 2003, Volume 10, Issue 12

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Living Will: A legal document that instructs your doctor in advance on what kinds of medical treatments you want to receive.

Nobody likes to think about becoming disabled by injury or illness. Unfortunately, life doesn't always work out the way we want it to. If we fall ill and are unable to communicate our wishes with regard to medical treatment, a thoroughly prepared living will can speak for us. Without this valuable document, the burden of final decisions could fall on a spouse or child, or worse, it could be placed in the hands of doctors or the courts. At the very least, these decisions are taken out of your hands.

Living wills are accompanied by a health care proxy (ie, a durable power of attorney naming the individuals who will make sure the terms of your living will are carried out). This decision can be difficult. Some people appoint a family member; others choose their attorney. You may select more than 1 person in the event that 1 of the 2 individuals cannot be present when difficult decisions need to be made quickly. It's recommended that you appoint 2. It's also a good idea to review your state's health care laws for any requirements that may be imposed on this individual.

NO STONE UNTURNED

The Die Broke Complete Book

of Money

Living wills can have a significant impact on the value of your estate. In (Harper Business; 2001), Stephen Pollan points out that the cost of a final extended hospital stay for a patient without a living will can be many times greater than that of a patient who has left specific instructions. Every dollar spent on your care is 1 less dollar that you may have intended for your heirs. You may wish that every effort is made to preserve your life, but without a living will, you could be allowed to die through inaction.

Of course, these are difficult decisions that should only be made following considerable thought. For example, what are your feelings about quality of life? Many living wills contain a clause stating that if there is no quality of life, no heroic measures should be taken to prolong your existence. To you, a loss of quality of life might mean that you are not, nor will you ever be, able to communicate with the outside world. To another individual, only severe and ongoing pain that cannot be diminished might define a lack of quality of life. That is why your wishes need to be stated as precisely as possible.

Pollan suggests that a living will also address the issue of stopping treatment. For example, you may have been receiving regular treatment or medication to treat hypertension or enhance heart function. Your health care provider, especially in today's litigious society, could be worried about liability if that treatment is stopped. If those are your wishes, make certain the individual named as your health care proxy is given the authority to withdraw all related forms of treatment.

THE POWER OF WORDS

Some people express the concern that signing a living will violates their religious preferences. To the contrary, if you do have special religious preferences that you want addressed, it's even more important that you make them clear in a living will. For example, some religions restrict the ability to withhold life support. However, if you want life support withheld, you should indicate in a living will that you don't want religious restrictions to apply in your case.

Living wills should be signed in front of 2 impartial witnesses, Pollan says. These individuals should not be in a position to inherit anything from your estate, play a role in your financial affairs, or be an employee of your health care provider. Once the living will is signed in the presence of these witnesses, it will override all other opinions and documents on what kinds of treatment you should receive. Living wills can also be used to specify that your organs be donated, and can outline other directives.

Most states have a set language that attorneys must use in drafting a living will and durable power of attorney for health care. This can vary from state to state, so it's important to talk with your attorney first to be aware of any restrictions imposed by state laws. In addition, if you spend time in more than 1 state, such as at a second home or vacation residence, it's a good idea to have a living will prepared in each state. And because life's situations frequently occur when we least expect them, take the time to regularly review your living will, making certain it reflects your current best interests.

Living Will Fast Facts

Despite the valuable purpose served by living wills, only 20% of Americans use them. While stipulating your feelings about life-and-death situations, living wills can contain additional important information. Keep the following recommendations in mind when preparing your own living will:

• Note detailed burial instructions or other arrangements you may want made, such as cremation and interment. Also, specify wishes for your eulogy and burial.

• Decide whether or not you would like to donate your organs. Organ donation can be critical in helping save the lives of others.

• Discuss the components of a living will with the people likely to be involved in your care, particularly your immediate family. The process of discussing your feelings can help crystallize your own thoughts, while informing others of your feelings.

• Talk about your living will with your doctor and provide them with a signed copy. If you're hospitalized, it becomes a part of your medical records.

• Keep a copy of your living will at home in an accessible place.

CME Quiz

1) A living will provides important medical treatment information to your:

  • All of the above

2) How many people should you appoint as a health care proxy?

  • As many as possible

3) A living will does not address:

  • Quality-of-life issues

4) Special religious preferences should not be included in a living will.

  • False

5) How many impartial witnesses should you have to sign your living will?

  • 1

Answers: 1) d; 2) b; 3) b; 4) b; 5) c.