Advance Directives - Living Wills

A living will is a written advance directive 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. It is sometimes called a directive or a declaration. Laws regulating living wills vary from state to state. For example, in 31 states a FIGURE 7.1
State laws governing living wills and appointment of health care agents, 2004 pregnant woman's living will cannot be honored if it asks for the withholding or withdrawal of life support because of restrictions in those states' statutes. (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 when preparing a living will include cardiopulmonary resuscitation (CPR), mechanical ventilation, artificial nutrition and hydration, and kidney dialysis.

Some Are Opposed to Nontreatment Directives

Some people point out that discussions about advance directives focus on discontinuing or withholding life-sustaining treatments. Wesley J. Smith, in Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder (New York: Times Books, 1997), notes that some advance directives only list one choice: nontreatment. According to Smith, if a person chooses to fight for his or her life, that person may be faced with the daunting task of writing out detailed treatment instructions.

This need not be the case. An advance directive form included in the model Uniform Health Care Decisions Act (UHCDA) offers several options that include treatments to prolong life. (See Figure 7.3, 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.

FIGURE 7.2
Pregnancy restrictions in living will statues, 2004

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 since it uses simplified language rather than legal or medical jargon. As of June 2004, "Five Wishes" met living will or advance directive criteria in 35 states and the District of Columbia; in the other 15, specific forms were necessary, 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 hydration as forms of medical treatment but as basic necessities needed for the preservation of life.