You need a living will!

 

Let's talk living wills. 

Sorry if I'm coming on too strong, but we are all going to die. And everyone deserves to die with dignity. This is why YOU need a living will. No one knows you better than you - not your partner or children, etc. Kudos if you've even had these conversations, but even better to put your wishes in writing! A living will is one part of estate planning. As you might have guessed, estate planning increases with age (legalzoom.com); unfortunately, not everyone grows old. While discussing death may be uncomfortable, actually dying without having your affairs in order could really be uncomfortable - for you, as your wishes may not be satisfied, and for the loved ones who may find themselves in the difficult situation of having to make decisions on your behalf while grappling with their own feelings. As a physician assistant, I've helped many clients create living wills. I've helped family members make informed decisions regarding the content of their living wills. And I've served as a designated healthcare advocate in scenarios where there was and was not a living will. Having done both, I'd much rather have a living will in place to serve as a guide - let's unpack this. 

What is a living will?

A living will is an advance healthcare directive that outlines your wishes should you become incapacitated and unable to speak for yourself. Many scenarios can lead to being in an altered conscious, unconscious or comatose state. And such a state may or may not occur at the end of life; regardless, you will benefit from documenting your wishes beforehand. In general, a living will designates a healthcare advocate (such as a spouse, sibling or adult child) to make decisions on your behalf; and outlines whether or not you wish to have life sustaining treatment. In addition to naming a healthcare advocate if you wish to do so, you will document whether or not you wish to receive the following:

• Cardiac resuscitation (CPR)
• Life-support (respirators, ventilators)
• Feeding tubes
• Blood or blood products
• Surgery or invasive diagnostic tests
• Kidney dialysis
• Antibiotics 
• Pain medication - even if it may inadvertently lead to addiction or hasten death 
• Anything else you might like to include...

While designating a healthcare advocate is not mandatory, you should do it if you can. There are nuances to every medical scenario, and a lot of gray area when it comes to the decision making process. Certainly, as a medical professional, we do our utmost in good faith and are under oath to not cause harm. We strive to care for our patients to honor dignity and preserve quality of life, delicately weighing the benefits and risks of interventions. However, a medical professional will likely not know you personally. If your first meeting is while you're incapacitated, your healthcare team would have no way of knowing the choices you would make for yourself. A healthcare advocate that knows YOU will be a huge asset to your healthcare team, and can help navigate your medical care when choices aren't so black and white.  

Who needs a living will?

If you have an opinion, then you should have a living will! Again, we all die and everyone should die with dignity. Not only will you benefit by ensuring your wishes are fulfilled, but your next of kin will benefit from NOT having to make decisions on your behalf. Yes, it can be done, but it is a burden. Oftentimes, the loved ones of the affected are racked with many feelings such as denial, disbelief, shock and perhaps anger or guilt. It is a distressing time, and making serious decisions is difficult. Depending on the prognosis and possible outcome, your loved ones may be starting the grieving process. Having a living will can be such a gift to relieve your family of the burden of having to be your surrogate decision maker. 

How do I make my living will legitimate?

Creating a living will need not be a costly or lengthy process. I'm writing this in the state of Pennsylvania, where a written will is acceptable, and notarization and witnesses are optional. If you prefer to have a more professional document, there are online services such as FormSwift from Dropbox and LegalZoom that allow you to create legal documents including a living will - fees apply. Some services offer a low cost trial period, during which you can create, print and save documents. The entire process takes about 20 minutes, and you can edit the document later if needed. Use this article as a guide to start brainstorming, and bring any questions to your healthcare provider before creating and/or finalizing your document. But a living and can be updated at any time, so don't delay!

I have a living will - now what do I do with it?

I recommend spreading your living will far and wide! Whether written or typed you can make physical and digital copies. Tell at least two of your loved ones where it can be found, and add a copy to your medical record. If applicable, provide copies to your attorney and funeral home director. A living will should be fluid rather than one and done. Perhaps you could update it annually - on the first of the year or your birthday to make it easy to remember to do. Something is better than nothing, but you want your living will to be current in terms of the care you'd like to receive (or not) as well the person(s) you designate to make decisions on your behalf. If your health status or family situation changes, then your living will may need to be updated as well. You may not want an ex-spouse or estranged child as your healthcare advocate, for example. 

What if I become incapacitated and I don't have a living will?

If you become incapacitated and don't have a living will, then your next of kin will likely make decisions on your behalf. There are so many different family dynamics. Sometimes the surrogate decision maker is obvious and uncontested; when it's not obvious, then things could get ugly. Worst case scenario, disputes have to be settled in court. You can see why having a living will created for you by you BEFORE possibly ending up in this predicament would be super helpful! Situations such as these are highly emotionally charged as it is, eliminate the possibility of a guessing game or family feud when it comes to receiving medical care if you're unable to be an active participate in decisions for your own life. 

Summary

Death and dying remain taboo topics, yet it's something we will all experience. Whether or not death is imminent, you may find yourself in a state where you are unable to actively participate in decision making about your own life. A living will is a type of advance directive that can help guide healthcare decisions to ensure your wishes are honored and unburden your next of kin. While these decisions may be tough to choose for ourselves, imagine having to do it for someone else! Creating a living will is quick and low cost, but the assistance and peace of mind it can provide you and your family is priceless. Create or update your living will TODAY.

Do you have a living will? Let me know in the comments! 

What questions do you have for me?