Living Wills Clarify Your Values, Wishes

The Terri Schiavo case earlier this year focused attention on the issue of legally appointing a friend or relative to make health-care decisions on your behalf should you become incapacitated. Designating such a person to make these decisions makes up just one aspect of an advance directive. Advance directives provide a means of communicating wishes for the kind of medical treatment we would want when we are not capable of deciding for ourselves.

Advance directives include:

• Communicating information to those who may make end-of-life decisions for you
• The legal appointment of a surrogate (or proxy) decision maker who can act on your behalf, and
• A living will document that describes aspects of medical treatment about which you are specifically concerned.

The single most important thing each of is can do is to have conversations with our loved ones about our wishes and values so they can honor them if and when they are called upon to do so. Unlike the dispute that occurred among Terry Schiavo’s family members, however, families and health professionals most often agree about what ought to be done for a critically or terminally ill family member. Thousands of people die every day in our health-care facilities after the family and loved ones decide to limit some form of medical treatment.

Living wills provide written documentation of your wishes related to medical treatment.  When writing a living will, you need to consider the circumstances in which you would—or would not—want medical treatment to stay alive. For example, would you want treatments to help you survive if you were permanently unconscious, in a persistent vegetative state, or severely mentally or physically disabled following an accident? Would you prefer hospice care? Would you wish to be organ donor after death?

In Minnesota, a living will must meet state requirements to be legally valid. Most health-care organizations suggest using the Minnesota Health Care Directive as a guide. This directive includes a living will format, a section on appointing a decision maker, and a list of possible situations to consider in end-of-life planning. You don’t need an attorney, but you do need signatures from at least two witnesses, neither of whom can be the appointed decision maker.

A common question is, “Can I change my living will or advance directive?” The answer is yes. Actually, it’s a good idea to review your living will each year with your decision maker(s). Remember that a living will has no influence on your care as long as you are capable of making decisions for yourself.

You don’t need to legally file an advance directive, but it’s important to give a copy to anyone who may be involved in making health care decisions for you. You should also let other family members know your wishes and tell them whom you have designated to make decisions on your behalf. You should also give a copy to your physician, your hospital, and keep one for your records.

Dianne Bartels is associate director of the University of Minnesota Center for Bioethics. For more information, visit the University of Minnesota Center for Bioethics Web site at http://www.bioethics.umn.edu. Click on Resource Center and then Advance Directives. This column is an educational service of the University of Minnesota. Advice presented should not take the place of an examination by a health-care professional. For more health-related information, go to http://www.healthtalk.umn.edu.