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Living wills clarify your values and wishes
By Dianne Bartels
From eNews, August 18, 2005
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
What's in the law
In 1990, Congress passed the Patient Self-Determination Act, which requires health care providers to inform all adult patients about their rights to accept or refuse medical or surgical treatment and the right to execute an advance directive. Before August 1, 1998, Minnesota law provided for several other types of directives, including living wills and mental health declarations. Today, you can use one form for all your health care instructions. In Minnesota, health care directives prepared in other states are legal if they meet the requirements of the other state's laws or the Minnesota requirements. However, requests for assisted suicide will not be followed. For more information, visit the Minnesota Department of Health.
The single most important thing each of us 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, and neither one can be the appointed decision maker. (For a free copy of the Minnesota Health Care Directive workbook and form, visit the U of M Medical Center, Fairview.)
Resuscitate or not
A Do-Not-Resuscitate (DNR) order is another kind of advance directive. It is a request to not have cardiopulmonary resuscitation or CPR done on you if your heart stops or if you stop breathing. (Unless told otherwise, hospital staff will try to help all patients who have stopped breathing or whose heart has stopped). You can use an advance directive form or tell your doctor that you don't want to be resuscitated, and the order would be noted in your medical chart.
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 has been the associate director of the Center for Bioethics since 1987. She is a registered nurse and one of the founders of the Minnesota Network of Ethics Committees.