Topic Overview

A living will is a type of advance directive that documents your wishes about end-of-life medical treatment, including life support, if you become unable to speak for yourself. In most cases, a living will and medical power of attorney, which names a health care agent, are completed at the same time.

All 50 states and the District of Columbia have laws about advance directives. But state laws vary in their requirements. Some states have a standard living will form to which you can add your own instructions.

Have your living will witnessed as your state requires, usually by two people who have nothing to gain or lose by doing so. Your state may require that your living will be notarized (witnessed by a notary public). A federal law called the Patient Self-Determination Act requires hospitals and nursing homes that receive Medicaid and Medicare funds to inform you that you have the right to fill out an advance directive. Many hospitals and nursing homes will give you forms that meet state requirements.

You do not need an attorney to complete a living will. But legal advice is helpful if your state's laws are unclear, your health history is complex, or there is conflict within your family.

To get copies of the forms for your state and instructions for completing the forms, contact the nonprofit organization Caring Connections at www.caringinfo.org or 1-800-658-8898. Give your doctor a copy of your living will to keep in your medical record. If you have more than one doctor, make sure that each doctor has a copy. Speak with your doctor and other health professionals to ensure that they understand the words you have used. Make sure that your family members and your health care agent also have copies. Some people may want to put a copy of their advance directive in an envelope on their refrigerator door.

Keep the following facts in mind when you are considering preparing a living will:

• You can change or revoke your living will at any time. Review your living will regularly. Many people find that their wishes about medical treatment change over time, even in a few months, as their health changes. You may change the forms to address your specific wishes. If you make significant changes to your living will, complete a new document.
• Your living will is only used if you can no longer make or communicate decisions for yourself. Normally, one or more doctors must certify that you lack capacity before your living will takes effect.
• If you become able to speak for yourself again, you can accept or refuse any treatment, no matter what you said in your living will.
• Some states may limit your right to refuse treatment in certain situations. You may need to specifically state in your advance directive that you do not want artificial hydration and nutrition, such as being fed through a tube.

Be specific when you complete your living will, but avoid being overly specific. Too much detail may limit your health care agent's ability to make decisions as your situation evolves, yet too little detail may not give your agent and family enough guidance in a specific situation. Be sure to talk with your agent about your beliefs and wishes.

• Although you cannot plan for every possible situation that may arise, some treatments are commonly used in end-of-life situations. These include cardiopulmonary resuscitation (CPR), ventilators, and artificial nutrition (feeding tubes) and fluids.
• Some types of health problems tend to be more common at the end of life, such as irreversible brain damage or a form of dementia such as Alzheimer's disease.
• In your living will, include some general information about whether you would want to have certain treatments or to have your life prolonged in certain situations. Talk these situations over with your health care agent, your family, and your doctor.
• If you have a chronic illness, talk with your doctor about what is likely to happen, what kinds of treatments you may receive, and how you feel about those treatments. Talk to your agent about your wishes based on these discussions.