Let’s start with a definition of Living Will. This has nothing to do with who gets what when you die. A living will has to do with how decisions are made about your health when you can’t make them. There are three parts to preparing your living will.
The first part is figuring out what you want. If your heart stops, do you want someone to attempt CPR? To shock you, and give you drugs to get your heart going again? If you are in a coma, do you want to be on a ventilator? Do you want to receive tube feedings? Hydration? Is there any point at which you’d like the life support to be stopped? Is there no point at which the you’d like life support to stop?
The second part is filling out the paperwork and getting it notarized. This makes it all official. For Washington state, the standard paperwork, which can be modified, is here. You can register your documents so doctors can retrieve them online here.
The third part is to talk to your relatives. They need to know what you want, they need to be able to ask questions and to get comfortable with the idea. The codicil to this is, if you have any relatives for whom you may be responsible later, this is a good time to ask them what they want.
These three steps are all equally important. For obvious reasons, you need to know what you want. The second part is important because it gives medical staff a jumping off point. But more importantly, it gives your family something to fall back on. I talked to a patient once who had two family members die. Both of them needed to have life support stopped. Both of them had talked with their families about what they wanted. For both of them, having the life support pulled was the sort of thing they said they wanted. But only one of them had a living will. My patient said even though they knew it was the right and wanted thing to do, not having those desires in writing meant they felt tormented and guilty about making the decision to end life support. When they did have it in writing, it changed everything.
I know for my family, with my grandma, having everything in writing helped a lot. Without the living will, I think we would have had an incredibly difficult time following her wishes, even as it became more and more obvious that she was never coming back. The living will gave us comfort that we were doing what she wanted, however hard it was to withdraw life support. Putting it in writing respects and supports the people who will need to carry out your wishes.
Talking to your family is just as important because if your family doesn’t agree, chances are quite good that your wishes will not be honored. This is true even if you have it in writing. Hospitals have been sued for trying to follow a living will against a family’s wishes, and generally the hospitals have lost—so they usually defer to the families.
Talking to your family also gives them a chance to decide if these are the sorts of decisions for which they are comfortable taking responsibility. If they agree with your living will, but think they’ll chicken out following it, or if they disagree with your living will and refuse to honor it, it’s time for a durable power of attorney for health care, which allows someone else to make these decisions. Again, it also opens up the conversation with the people you care about, without having a subtext of, “You’re old and are going to die soon.”
Ok, so are you convinced yet? Remember, you could be hit by a bus tomorrow, and neither be fine nor die. So get hopping, and sort out your living will.
