What Is a Living Will?
Key takeaways:
A living will is a healthcare directive that gives you the power to express your end-of-life wishes when you can’t communicate those choices directly.
You can create a living will by completing a form that’s valid in your state or by hiring an attorney to help you prepare the document.
Other advance directives, such as a medical power of attorney, can be used alongside a living will to ensure that any decisions made on your behalf about your health or estate reflect your preferences.
Table of contents
Many people avoid thinking about serious illness and death, but it's important to do so. It’s also vital to take action to ensure your end-of-life wishes are known.
It’s impossible to predict when you might have a medical emergency that leaves you unable to communicate or make decisions. A living will can help you prepare for this situation by letting you express your preferences concerning medical care in advance.
This legal document lets you outline what types of medical interventions you want or if there are life-prolonging efforts you prefer not to receive. With a living will, you can be the one making decisions about your health, instead of leaving the choice — or the burden — to someone else.
What is the purpose of a living will?
A living will is a legal document that expresses your wishes when you cannot. It is a type of advance directive that provides instructions for managing your healthcare if you are physically or mentally unable to express your preferences. A living puts your wishes in writing so that healthcare providers will know what medical treatments you want and which ones you don’t.
If you have a terminal condition or are not expected to recover after a life-threatening medical emergency, decisions may have to be made about your care. A living will can answer questions such as:
In what situations should you be placed on life support?
Should CPR be used if your heart stops beating?
What kinds of medications and procedures do you want to receive?
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Are there drawbacks to having a living will?
While a living will can play an important role in giving you control over your health, this legal document has some limitations.
Doctors make the last call: A living will only go into effect if you need life-sustaining treatment. If the doctor overseeing your care doesn't believe that your condition qualifies as an end-of-life situation, your living will won't be honored. Say you have written in your living will that you don't want to be placed on a ventilator if there is only a slim chance of recovery. Typically, two doctors have to agree that there is little chance of recovery in order for your wishes to be honored. A doctor can refuse to honor your wishes if it goes against their personal beliefs or the healthcare facility's policies. Your case may also go before an ethics committee.
Loved ones won't have a say in your care: Some people may want their family members to be involved in the decision-making concerning their end-of-life care. A living will would likely override any decisions made by relatives or other loved ones.
You may miss out on life-saving medical advancements: If you created a living will years ago, your decisions were based on the interventions available at that time. If you have not updated your living will, you may end up refusing cutting-edge treatments that have a good chance of saving your life. A study published in the Journal of Healthcare Risk Management found that living wills can cause medical treatment to be stopped too soon.
Elements of a living will
There are a number of preferences you might include in a living will. For example, you can indicate:
Whether you want CPR performed if your heart stops beating. A DNR (do not resuscitate) order would instruct your medical team to refrain from using CPR.
Whether you want to be placed on a ventilator if you can't breathe on your own. A DNI (do not intubate) order would indicate that you don’t want to be intubated.
Whether you want a feeding tube inserted into your body to deliver nutrition and liquids if you can't eat or drink.
Whether there are other types of treatments you want to refuse, such as dialysis.
Whether you want your organs donated.
While your living will should express your unique wishes, here are some examples of statements you might include:
“If I am not expected to survive, I request that any procedures that might extend my life be withheld.”
“In the event that I cannot breathe on my own, I specifically do not want to be placed on a ventilator.”
“If there is little chance of recovery, I do not want tube feedings to be initiated.”
How to write a living will
The National Institute on Aging recommends that you spend time thinking about your values and preferences before you create a living will. For example, one person might want all possible measures taken to extend their life, while another might decide that they would rather not be resuscitated. Some people have religious or spiritual beliefs that influence whether they would choose to be placed on life support.
A primary care doctor can help you understand the types of wishes you should state in your living will. Your healthcare providers know your medical history and can discuss how you may want to craft your living will. Medicare Part B covers advance care planning — which may include completing an advance directive — as part of your annual wellness visit.
There are various other names for a living will, and the rules governing them vary by state. Once you know your preferences, you can complete your living will by filling out a form that’s valid in your state. You can find out what forms you need from sources such as:
AARP
Your state health department
Your local Area Agency on Aging
Your doctor's office
The form will indicate if there are other steps you must take to make the living will official, such as getting the document notarized. You can also hire an estate planning attorney or other lawyer to create your living will for you.
Once you have a living will, make sure you keep it with your organized medical records. Give copies to family members and loved ones so they know your wishes. Also make sure you have your living will on file with your healthcare providers. The National Institute on Aging suggests that you review your living will every year and after major life events to make sure the document still reflects your wishes.
How is a living will different from other advance directives?
A living will is just one of several types of advance directives. You may find that other documents better suit your needs or decide to use them in addition to your living will. These other advance directives include:
Do-not-resuscitate order: Known as a DNR, this legal document indicates that you do not want to be resuscitated in an emergency. It’s signed by you and your doctor.
Medical power of attorney: Also known as a healthcare power of attorney or a healthcare proxy, this legal document lets you appoint the person you want to make medical decisions if you can't make them for yourself.
Advance euthanasia directive: This legal document outlines a person's request for medical assistance in dying under certain conditions. Whether such a directive would be honored depends on a number of factors, including whether medical aid in dying is legal in your state.
Living trust: This is a legal entity that stores your assets and lets you appoint a trustee to manage them should you become unable to do so. The trust would also ensure that your assets are allocated according to your wishes after your death. Unlike a will, which is a public document, a living trust — and anything in it — remains private.
Will: Perhaps the best-known advance directive, a will provides instructions about how you want your estate and assets to be disbursed after you die. A will may also include your wishes regarding guardianship for minor children.
How much does a living will cost?
You may be able to create a living will for free if you do it yourself. Or it can cost $1,000 or more if you need help preparing the document.
Some states require you to have your living will notarized, and it’s a good idea to do so regardless of where you live. Notary fees typically range from $5 to $25, but you may be able to access free notary services through your bank, credit union, or labor union.
ContractsCounsel, a marketplace of attorneys, surveyed its members and found that lawyers generally charge between $500 and $750 to prepare a living will. However, some estate attorneys may charge much more or sell living will preparation in a package with other services.
Who should have a living will?
Anyone could find themselves in need of a living will. In a 2020 Gallup survey, only 45% of people in the United States said they had one. The figure was 72% for people 65 and older.
Older people and those who have serious medical conditions or are preparing for surgery may be more likely to find themselves facing end-of-life concerns than people who are younger and healthier, but an accident or medical crisis can happen to anybody.
When should you establish a living will?
It's never too early for an adult to establish a living will. In fact, the Academy of Florida Elder Law Attorneys points out that parents lose the legal right to make healthcare decisions for children after they turn 18. So it's a good idea for anyone 19 or older to have a living will. And it's best to prepare the document when you're healthy and able to carefully consider your preferences.
The bottom line
A living will gives you a voice in the management of your healthcare when you are unable to speak for yourself. By following your state’s rules for preparing this kind of document and getting guidance from your doctor, you can create a living will that lets you determine which medical interventions you want and which ones you don’t when you’re near the end of your life.
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References
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