By Laura Herman, Dementia and Eldercare Professional
A living will is different from a last will and testament and both documents are important parts of planning for the future.
Many people are familiar with the last will and testament, which details your wishes regarding how you want your property distributed after your death. In contrast, a living will details your wishes regarding the kind of healthcare you want if you can no longer speak for yourself.
A living will is an important part of a process known as advance care planning – a process in which you consider the types of health care decisions that may have to be made in the future, and document your preferences. Advance care planning ensures that, should the time come when you can’t speak for yourself, your healthcare team and family can honor your wishes with less struggle over potentially difficult decisions.
A good advance care plan is truly a gift you give your loved ones, and your future self.
What is a Living Will?
Living wills address the type of care you’d need if you were dying or permanently unconscious. This can include issues such as:
- Cardiopulmonary resuscitation (CPR)
- Ventilators (breathing machines)
- Tube feeding
- Intravenous fluids
- Intensive care
These types of treatments can be very uncomfortable, and while they make plenty of sense for some people in some situations, many people who are dying would prefer to live out their days in the peace and comfort of their home rather than in a stressful medical environment.
There’s no right or wrong answer to these questions, and most people's preferences change throughout their life, depending on the general state of health, and whether they feel people depend on them to remain alive or not. A living will should be updated periodically to reflect changes in philosophy or life situation.
It’s recommended that every adult have a living will, because regardless of age, there’s always the potential for sudden accidents and changes in health. The need for a living will becomes more urgent as age increases or health declines.
A Living Will is an Advance Directive, and Part of an Advance Care Plan
The term advance directives includes any of the legal documents that provide direction regarding potential future care. Each of the documents listed below are types of advance directives, and there are other, less commonly used, advance directives not listed here.
Sometimes the term advance directive is used to refer to a single document that contains both the living will and the healthcare power of attorney.
Taken together, these advance directive documents compose an advance care plan. An advance care plan can include several separate documents which might seem similar, but have different functions or come into play under different circumstances.
An advance care plan may include:
Living Will - A living will provides guidance to your loved ones and future healthcare providers as to how you wish to be treated if you are dying or can’t speak for yourself due to unconsciousness or serious illness. Sometimes a living will form also contains a healthcare power of attorney to designate a healthcare proxy.
Healthcare Power of Attorney - The Healthcare Power of Attorney grants a person the authority to make medical decisions on your behalf when and if you can’t make them for yourself.
A healthcare power of attorney is different from a general durable power of attorney. Learn more about Healthcare Power of Attorney documents here.
DNR - DNR stands for “Do Not Resuscitate”. In some places it’s called AND for “Allow Natural Death”. This document permits emergency responders and other medical personnel to refrain from providing CPR to restart your heart should they find you without a heartbeat.
POLST - This form has different names in different states, including Provider Orders for Life-Sustaining Treatment, Medical Orders for Scope of Treatment, and a dozen other variations. It’s most often called POLST when speaking in generalities. The POLST isn’t recognized in every state. The POLST is similar to the DNR in that it gives healthcare personnel legal permission to refrain from life-sustaining treatment like CPR. It can also limit other medical treatment, such as intubation, tube feeding, or intensive care. In many states, you won’t need a separate DNR form if you have a POLST. A POLST is important even if you have a living will because emergency medical providers can’t withhold life-saving treatment based on a living will. They need a doctor’s order – a POLST – to do so.
Is your frail loved one’s quality of life being affected by unnecessary life-sustaining treatment? Learn more about POLSTs here.
Where Should a Living Will be Kept?
Your original living will should be kept in a secure yet accessible place, for example, in a fire safe at home. To ensure it can be found promptly when needed, keep it in a consistent location, tell your loved ones where it’s kept, and consider carrying a card in your wallet that specifies the location.
Copies of your living will should be given to:
- Your healthcare proxy, and any alternate proxies
- Your primary healthcare provider
- Healthcare teams, including your hospice team, senior living facility, nursing home or hospital staff, etc.
Keep track of who has received copies, so that if you update it in the future you can ensure that everyone gets the updated version. This can reduce the chance of mistakes or unnecessary confusion in an emergency if there are multiple versions of the living will floating around.
What Decisions Go In to a Living Will?
If you were to be the victim of a sudden accident, or unexpected health crisis, such as a severe stroke, how aggressively would you want healthcare providers to work to keep you alive? In order to answer this question, you’ll need to consider several potentially tough topics.
- How strong is my health and quality of life now and how strong would it likely be after treatment?
- What makes life worth living for me? How do I measure quality of life?
- What religious or spiritual beliefs might come into play regarding pursuing medical treatment versus letting nature take its course?
- Is there a particular event, goal, or milestone I’d like to live to achieve or see? Will my wishes for treatment change after that time?
- Do I want to be an organ and tissue donor?
- Do I want to be kept pain-free, even if it makes me more drowsy?
- Do I have preferences about which types of medications or non-drug treatments I’d like to use to manage pain? Are there scenarios where I’d make exceptions, such as if the pain is very excruciating?
Because it’s impossible to anticipate and prepare for every potential possibility, it’s very important to designate a healthcare proxy with a power of attorney for healthcare who understands your preferences and can advocate for you and make decisions based on your wishes in real time.
Who Needs to Know About Your Living Will?
Simply documenting your wishes is a good start, but the real value of a living will comes when you take the time to discuss your preferences ahead of time with those who are likely to be the key players in your healthcare when you can’t speak for yourself. You can spare your loved ones a lot of heartache, and make it much more likely that your wishes will be honored.
Talk about your advance care wishes with:
- Your primary doctor
- Your hospice or healthcare team
- Your spouse or partner
- Other key friends or family members
If everyone is on the same page, they can work together as a team without the friction and distress that may be present if they all have their own opinion on how you would have wanted to handle the situation.
It’s recommended to review your living will every decade, or when key events occur in your life, including when:
- A significant loved one dies
- There’s a divorce or major change in the family
- You’re diagnosed with a serious health condition
- Your general health starts to decline
- You move to a new home, or someone moves in with you
Resources for Completing Your Living Will
Technically, completing a living will can be as simple as printing out the proper state-specific form, filling in the blanks and signing it. In reality, however, advance care planning is a process that requires consideration and communication with those who are likely to be around when you can’t speak for yourself.
Advance Care Planning can be Confusing – Guidance Can Help
End of life matters can be emotionally difficult to consider. They can be confusing to those who’ve had limited exposure to the healthcare system. It’s very valuable to have a professional to guide you and your loved ones through the process to ensure you understand the decisions you’re making, and that your wishes are then understood by those around you. An elder law attorney, geriatric care manager, or social worker can generally help with this. There are also some excellent resources online to assist you at no charge.
PREPARE for Your Care - Free Advance Care Planning Forms
PREPARE is a free service supported by funding by various government agencies, including the American Cancer Society and National Institute on Aging. Access free advance directive forms for every state, and receive optional free guidance to understand them in English or Spanish.
The ABA Tool Kit for Health Care Advance Planning - Guidance for the Advance Care Planning Process
This free Tool Kit for Health Care Advance Planning was produced by the American Bar Association with funding provided by the Last Acts Campaign and the U.S. Administration on Aging. It’s essentially a workbook that walks you through the decision-making process of selecting a health care proxy, considering goals and priorities near the end of life, and having the conversations with family and healthcare providers that are vital to ensuring your advance care plans are understood and honored when the time comes.
American Bar Association’s Multistate Guide and Advance Directive Form
This form created by the ABA is more complicated than many because it’s designed to meet the legal requirements for almost every state. This is handy for individuals who live in multiple states, since they only need a single form, rather than different forms for different states.
Not sure how to talk to your loved ones about the possibility of hospice care? Gain valuable insight on how to approach this tough topic here.
A Living Will is a Gift You Give Your Loved Ones and Your Future Self
A living will is an important part of the advance care planning process, in which you consider potential health scenarios you might encounter if you were unable to speak for yourself.
The living documents and communicates your wishes about invasive treatment versus comfort care. Some living will forms also allow you to designate a healthcare proxy who can make decisions on your behalf if needed.
Although technically, the living will is a form to complete, in its bigger sense, it’s also a conversation in which you discuss your wishes with those who are likely to be around when or if you can’t speak for yourself. By completing the living will and this planning process in advance, you can ensure your wishes are honored, and spare your loved ones the unnecessary grief and hardship of grappling over what they should do for you in potentially challenging or tragic health scenarios.
Are you curious about comfort care? Read more about comfort care here.
- “Advance Care Planning: Health Care Directives.” National Institute on Aging, 15 January 2018, www.nia.nih.gov/health/advance-care-planning-health-care-directives.
- “Tool Kit for Health Care Advance Planning.” American Bar Association Commission on Law and Aging, 3rd Edition 2020, www.americanbar.org/content/dam/aba/administrative/law_aging/2020-tool-kit-hcap.pdf.
- Singleton, Amanda.“Why All Adults Should Have a Living Will.” AARP Family Caregiving, 09 December 2021, www.aarp.org/caregiving/financial-legal/info-2019/what-is-a-living-will.html.