special subjects
Advance Directives
Living will
A living will is a limited document that expresses a person’s preferences for their treatment and care, normally in connection with The Dying Patient (it is called a “living” will because it is in effect while the person is still alive). In many states, the document is more formally called a medical directive to doctors or a declaration. State laws vary greatly regarding scope and applicability of living wills. A living will allows people to express preferences for the amount and nature of their health care, from no interventions to maximum treatment. Detailed treatment preferences can be helpful because they provide more specific guidance to health care professionals. However, living wills completed long before a person experiences a life-limiting disorder have not usually been very helpful because, among other reasons, many people change their preferences as their circumstances change. Including information in a living will about one’s core values relating to end-of-life care, personal priorities, and goals of care can be just as helpful, if not more so, than specific treatment wishes. A living will cannot compel health care professionals to provide health care that is medically or ethically unwarranted. To be legally valid, a living will must comply with state law. A few states require that living wills be written in a fairly standardized way. Most states are more flexible, permitting any language as long as the document is appropriately signed and either witnessed or notarized. In most states, a health care professional involved in the patient’s care cannot be a witness. A document that does not comply with state law requirements for statutory living wills may still serve as reliable evidence of a patient’s wishes if it appears to be an authentic expression of the those wishes. Living wills go into effect when people are no longer able to make their own health care decisions and a medical condition specified in the directive—typically a terminal condition, Vegetative State and Minimally Conscious State , or the end-stage of a chronic condition—is diagnosed. Often, state law provides a process for confirming and documenting the loss of decisional capacity and the medical condition. 