Advance Directives - Living Wills

As mentioned previously, a living will is one part of an advance directive. It is a document that outlines a patient's preferences about end-of-life medical treatments in the event that he or she is unable to communicate or make his or her own decisions. Laws regulating living wills vary from state to state. For example, thirty-one states did not allow the withdrawal of life support from pregnant patients in 2004. Thus, a pregnant woman's living will could not be honored in those states if the living will asked for the withholding or withdrawal of life support. (See Figure 7.2.)

Living wills enable people to list the types of medical treatments they want or do not want. It is therefore important for an individual contemplating a living will to know what these treatments involve. Some examples of life-prolonging treatments patients should consider FIGURE 7.1 State laws governing living wills and appointment of health care agents, 2004 "State Statutes Governing Living Wills and Appointment of Health Care Agents," in End-of-Life Law Digest, The National Hospice and Palliative Care Organization, 2004when preparing a living will include cardiopulmonary resuscitation (CPR), mechanical ventilation, artificial nutrition and hydration, and kidney dialysis.

An advance directive form included in the model Uniform Health Care Decisions Act (UHCDA) offers several options that include treatments to prolong life. (See Table 7.1, Part 2: Instructions for Health Care.) This model law was approved by the National Conference of Commissioners on Uniform State Laws in 1993 to provide some consistency among state advance directives and remained a model law as of June 2006.

Another form, called "Five Wishes," was developed in Florida by a nonprofit organization called Aging with Dignity and is now distributed nationwide. The document probes legal and medical issues as well as spiritual and emotional ones. It even outlines small details, such as requests for favorite music to be played and poems to be read, and provides space for individuals to record their wishes for funeral arrangements. The document is relatively easy to complete because it uses simplified language rather than legal or medical jargon. As of June 2005, "Five Wishes" met living will or advance directive criteria in thirty-seven states and the District of FIGURE 7.2 State laws governing the withdrawal of life support from pregnant patients, 2004 "Pregnancy Restrictions in Living Will Statutes," in End-of-Life Law Digest, The National Hospice and Palliative Care Organization, 2004Columbia. It did not meet advance directive criteria in these thirteen states: Oregon, Nevada, Utah, Texas, Oklahoma, Kansas, Alabama, Kentucky, Indiana, Ohio, Wisconsin, Vermont, and New Hampshire. Other forms were necessary in those states, although the "Five Wishes" document can still serve as a guide for family and physicians.

Pro-Life Alternative to Living Wills

The National Right to Life Committee (NRLC) opposes active and passive euthanasia and offers an alternative to the standard living will. Called the "Will to Live," it does not consider artificial nutrition and hydra-tion as forms of medical treatment but as basic necessities for the preservation of life.