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Living wills and advance directives for medical decisions
What treatments would you want?
In determining your wishes, think about your values, such as the importance to you of being independent and self-sufficient, and what you feel would make your life not worth living. Would you want treatment to extend life in any situation? Would you want treatment only if a cure is possible? Would you want palliative care to ease pain and discomfort if you were terminally ill?
Although you can't predict what medical situations will arise, be sure to discuss the following treatments. It may help to talk with your doctor about these, especially if you have questions.
- Resuscitation. Restarts the heart when it has stopped beating (cardiac death). Determine if and when you would want to be resuscitated by cardiopulmonary resuscitation (CPR) or by a device that delivers an electric shock to stimulate the heart.
- Mechanical ventilation. Takes over your breathing if you're unable to do so. Consider if, when and for how long you would want to be placed on a mechanical ventilator.
- Nutritional and hydration assistance. Supplies the body with nutrients and fluids intravenously or via a tube in the stomach. Decide if, when and for how long you would want to be fed in this manner.
- Dialysis. Removes waste from your blood and manages fluid levels if your kidneys no longer function. Determine if, when and for how long you would want to receive this treatment.
Organ donation
You can also specify in your advance directives any wishes you have about donating your organs, eyes and tissues for transplantation or your body for scientific study. If you wish to donate your body for scientific study, contact the medical school closest to your home for details.
Fill out the forms for your state
Your advance directives should be in writing. Each state has its own laws regarding advance directives. Although it isn't required, you may want to consult an attorney about this process. State-specific forms are available from a variety of Web sites. The National Hospice and Palliative Care Organization has free forms on its Web site.
Once you've filled out the forms, give copies to your doctor, the person you've chosen as your health care agent and your family members. Your instinct might be to put your advance directives somewhere safe, like a safe-deposit box, but that will only make it difficult for your loved ones to find the forms when they need them.
Review your advance directives from time to time
As your health changes or your perspective on life changes, you might reconsider some of your advance directives. Read over your advance directives from time to time to see if you want to revise any of the instructions. You can change your mind about your advance directives at any time.
To revise your advance directives, you follow the same steps you used to create them. Get new advance directive forms to fill out. Discuss your changes with your friends, family and doctor. Then distribute copies of the new advance directives and ask everyone to destroy the earlier version.
If there isn't time to redo the paperwork, you can always cancel your advance directive by telling your doctor and your family. Remember, a living will or medical POA only goes into effect if you are unable to make medical decisions for yourself, as determined by your doctors.
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- Litin SC, ed. Mayo Clinic Family Health Book.3rd ed.. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2003:141.
- 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.
- What are advance directives? National Hospice and Palliative Care Organization. http://www.caringinfo.org/PlanningAhead/AdvanceDirectives/WhatAreAdvanceDirectives.htm. Accessed June 11, 2009.
- Preparing your advance directives. National Hospice and Palliative Care Organization. http://www.caringinfo.org/PlanningAhead/AdvanceDirectives/WritingYourAdvanceDirectives.htm. Accessed June 11, 2009.
- Creagan ET (expert opinion). Mayo Clinic, Rochester, Minn., June 11, 2009.
- Takahashi PY (expert opinion). Mayo Clinic, Rochester, Minn., June 11, 2009.
- 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.
