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Living Will


Introduction

In December 1991, a federal bill called the "Patient Self- Determination Act" (PSDA) was enacted which set universal standards for informing the public of their legal options for refusing or accepting medical treatment. The bill affects all health-care facilities, including hospitals, health maintenance organizations, home health-care services, nursing homes, and hospices, that accept federal funding. With each admittance to one these facilities comes a form explaining the state's law regarding acceptance or refusal of medical treatment and the institution's policy concerning it. You will be asked if you have a living will or health-care proxy and, if not, you will be asked to make certain choices about your future treatment.

Although the PSDA was a major breakthrough in patients' rights, the hospital admittance room is not the ideal location in which to first consider the issue of refusing life-sustaining medical treatment. This should be done with careful consideration and probably with the advice and counsel of your family, doctor, and lawyer. In order that your carefully considered thoughts and desires are recognized and carried out, the execution of a legally binding living will or advance directive is recommended.

In most states, patients can protect their rights by completing a legislatively approved living will. In those states which do not recognize living wills, existing case law permits the use of a Durable Power of Attorney for Health Care (DPAHC) to create a health-care proxy who will make certain your wishes are observed.


What Is a Living Will and Why Is One Necessary?

Modern medical technology, with its ability to extend life beyond consciousness and the body's ability to sustain itself naturally, poses new problems for many people. Even though one may feel strongly about avoiding artificial life-support systems, and "dying with dignity," the lack of a written, legally binding document stating such, often means that someone else must decide when exactly death will come once the patient has lost the competence to make such a decision. A number of elements come into play in deciding the circumstances of one's death. Often the overriding considerations are institutional involving hospital policies and state laws without regard for personal wishes. A living will and a durable power of attorney for health care represent the best possible chance that a patient's intentions will be honored.

A living will, by definition, is a will in which the signer either requests not to be kept alive by medical life-support systems in the event of a terminal illness or specifies precisely which particular forms of support are not permissible. Typical treatments excluded from use by a living will include: cardiac resuscitation, feeding and fluid tubes, mechanical respiration, antibiotics, surgery, dialysis, intravenous lines, chemotherapy, and blood transfusions.

A durable power of attorney for health care is a legally binding document appointing a decision-making proxy for health- care issues if the patient should become incompetent to make such decisions.

The living will and DPAHC together are examples of what is known as an Advance Directive.


A Generic Living Will

Although the PSDA set standards for informing patients of their rights, it did not establish a single, universal standard for living wills and durable powers of attorney. Each state was left to its own devices in regulating the rights of patient's self determination. Most states have specific living will and durable power of attorney forms, which vary considerably from one state to another. To obtain forms contact your state's Department of Health or its equivalent (see the end of this article for a state-by-state listing of departments and telephone numbers). Whether or not your state has a formal living will document, there is wisdom in recording your own specific wishes in a less restrictive generic living will in addition to filling out the state's form. The generic living will will give you broader powers in determining your ultimate care and, by specifying exactly what to exclude, allow you to avoid the vagueness and limitations of many state forms.

Once executed, the living will should be kept with your important papers, and additional signed copies should be given to your doctors, family, and proxy as well as to anyone else who may have to come forth with the document on your behalf. The location of safekeeping should be made known to others in order that it can be recovered quickly. For this reason a safe-deposit box is not recommended for storing the living will.

The following is an example of a generic living will:



________________________________________________

LIVING WILL DECLARATION


To my family, doctors, hospitals, and all those concerned with my care: I, ________________________ , being of sound mind willfully and voluntarily make this declaration to be followed if I become incompetent. This declaration reflects my firm and settled commitment to refuse life-sustaining treatment under the circumstances indicated below.

These directions express my legal right to refuse treatment. I expect the above mentioned parties to regard themselves as legally and morally bound to act in accordance with my wishes, free, thereby, of any legal liability for having followed my directions.

1. I direct my attending physician to withhold or withdraw life-sustaining treatment that serves only to prolong the process of my dying, if I should be in a incurable or irreversible mental or physical condition with no reasonable expectation of recovery.

2. I direct that treatment be limited to measures to keep me comfortable and to relieve pain, including any pain that might occur by withholding or withdrawing life- sustaining treatment.

3. In addition, if I am in the condition described above, I feel especially strongly about not wanting the following forms of treatment:

a.

b.

c. (etc., as necessary)

Other Instruction:

4. I designate, (name) of (address), as my surrogate to make medical treatment decisions for me in a manner consistent with this declaration, if I should be incompetent and in a terminal condition or in a state of permanent unconsciousness. If the person I have named above is unable to act on my behalf, I authorize the following person to do so: (name) of (address).


This Living Will Declaration expresses my wishes, and the fact that I may have executed a form specified by state law shall not be construed as limiting or contradicting this Declaration, which is an expression of my common-law and constitutional rights.


I make this declaration on this the ____ day of __________ , 1996





______________________________ _____________________________ Declarant Declarant's Address



______________________________ _____________________________ Witness Witness's Address



______________________________ _____________________________ Witness Witness's Address



NOTES

Paragraph three allows you to list all of the specific treatments you wish to exclude from receiving. There is no obligation to fill in this section as the remainder of the Declaration will represent your wishes to withhold treatment. If you do have strong feelings about specifying treatments to avoid. Examples include: antibiotics, artificial feeding and fluid administration, blood transfusion, cardiac resuscitation, chemotherapy, dialysis, intravenous lines, invasive tests, mechanical respiration, radiation therapy, and surgery.

This paragraph also permits you to list any special instruction you might have. Examples of such instructon might include preference for at-home or hospice care as the end of a terminal illness is approached; further instruction concerning pain relief; explanation of when life-support systems may be used; and feelings about religious practices or customs at the terminal stage of illness.


________________________________________________





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