How Effective Are Living Wills?

by Robin Elizabeth Margolis
A living will should be communicated to family members and physicians.

A living will should be communicated to family members and physicians.

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Living wills, also known as advanced healthcare directives or AHCDs, are documents that describe your preferences for medical treatment if you experience a serious accident or illness that leaves you unable to communicate your wishes to your doctor. You can make your living will more effective -- increasing the likelihood that your wishes will be obeyed -- by taking certain precautions.

The Growing Need for Living Wills

Prior to the mid-20th century, living wills were usually unnecessary. People usually died very quickly once life-threatening symptoms from accidents and illnesses appeared. Living wills address a modern medical problem caused by major medical advances in life-sustaining treatment -- patients continuing to live, even though they might prefer to die, because they cannot communicate their wishes to their doctors. Many people do not want to be kept alive for years while suffering from medical conditions such as long-term comas, complete paralysis, or substantial loss of their mental faculties, sometimes accompanied by constant pain.

History

The first living will document was created by attorney Luis Kutner in 1967, after he witnessed the painful and prolonged illness of a close friend. In 1976, California passed the first state law legalizing living wills. A federal law, the Patient Self-Determination Act of 1990, required most medical facilities to give adult patients information about their right to make a living will under state law. By 1992, living wills were legal in all 50 states.

Effectiveness

There has been considerable debate among health care policy experts regarding the effectiveness of living wills. Patients' wishes about end-of-life care are frequently not carried out, for many reasons. Patients often fail to prepare a living wills, but even if they do, they may store it in a desk or safe deposit box where others cannot find it. They may not discuss their living will, or they may fail to give copies to physicians, family members or friends. For their part, physicians do not always read living wills submitted by patients, or sometimes they ignore living wills written in vague language. They may place their professional judgment ahead of patients' wishes, or defer to family members and friends instead of patients' requests. Some patients have sued their physicians for disregarding their living wills.

Making Your Living Will More Effective

You can take precautions to make your living will more effective. Write your living will in clear language. Give copies of your living will to your family members and friends and tell them where you are storing the original. Make an appointment with your physicians, discuss your living will with them and give them copies of it. Consider placing your living will with an online depository, such as the U.S. Living Will Registry. You may also wish to draft a health care power of attorney in addition to your living will, designating someone you trust as your health care agent or proxy if you are unable to make your own medical decisions. Discuss the health care POA with your agent and give copies to your agent, your doctors, your family members and your friends. Keep the original of the POA with the original of your living will. Your agent can enforce your living will and deal with unexpected medical situations not covered in its provisions.