Description of Advance Directives, Living Wills, & Code Status

By Chris Blank

Headline-grabbing circumstances such as the case of Terri Schiavo, who spent more than a decade in a vegetative state, illustrate the complications that can arise when there are no clear instructions in place concerning catastrophic illness or end-of-life care. Advance directives, code status and living wills are three instruments that can provide guidance to your family and to medical professionals about your medical treatment. Having these kinds of instructions in place can provide direction for your medical care if you should become incapacitated.

Legalities of End-of-Life Care

Without clear instructions in place, hospital policy and medical opinion of the physician govern the course of treatment of life-threatening illness or injury. In many cases, these policies and treatments go against what the patient would have authorized had she been mentally competent. In other cases, unless a patient has made her wishes known in advance, hospitals and other medical providers are bound by the law to continue to administer treatment, even when the indications are strong that the patient's chances of eventual recovery are small or nonexistent. Disputes among family members concerning what the ill person would have wanted often erupt, and are frequently only settled after contentious legal action.

Advance Directives

Advance directives are documents that provide specific instructions for medical care professionals and facilities concerning your wishes that take effect if you should become incapacitated. A medical directive describes the type of care you wish to receive for life-threatening illness or injury, including medications and surgery. A health care proxy, which is similar to a durable power of attorney for health care, assigns the authority to a trusted person such as a family member or a friend to convey your wishes. You must draft a medical directive and assign a health care proxy while you are mentally competent.

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Living Wills

A living will is a type of advance directive that deals specifically with whether to administer or withhold life support or heroic medical intervention in the event that you become terminally ill or suffer an injury with no reasonable chance of recovery. A living will addresses issues such as whether to administer or withhold artificial feeding, anesthesia, cardiopulmonary resuscitation, or CPR and life support. Living wills are legally binding documents in 42 states and the District of Columbia. In the remaining states, a living will represents concrete evidence of a patient's wishes.

Code Status

Hospitals use the term code status to describe the type of treatment you should receive If your heart stops beating or your lungs fail. A code status determination such as a do-not-resuscitate order communicates your wishes to the medical facility. For instance, in the case of full cardiac arrest, code status determines whether you should receive CPR to attempt to restore a heartbeat. If your lungs fail, code status determines whether you should be connected to a breathing machine while doctors attempt to treat the underlying condition that caused your breathing to stop. You may also issue instructions concerning feeding tubes, pacemakers and other invasive procedures at the same time. However, a DNR or other code status instruction supplements rather than replaces advance directives.

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What Is the Difference Between a Living Will & a Last Will & Testament?



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Does a Living Will Replace a Will?

A living will and a last will and testament are both part of a comprehensive estate plan, but they deal with different issues. A living will allows you to express your end-of-life health care wishes. A last will and testament, usually referred to as a will, is the document you use to give directions for the handling of your affairs after your death. These documents are designed to work together; signing a living will does not replace your last will and testament.

Healthcare Proxies Vs. Living Wills

It is important to communicate with your doctor when medical care must be administered. Being able to convey your wishes and make decisions is the key to controlling what form of treatment and care you receive. An advance directive, such as a living will, makes it possible for you to put your wishes in writing ahead of time, so they can be followed if you are too sick or injured to consult with your doctor. A health care proxy, another form of advance directive, allows you to appoint someone to make health care decisions for you.

Standard Will Vs. Living Will

Planning your estate may involve creating several documents to address your end-of-life care before you die and your property after you die. Two of these documents may be a will and living will. A will directs the distribution of your assets after you die and a living will directs your health care while you are alive.

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