Planning for the Future: A Living Will Update

What if you suffered a traumatic head injury or a heart attack and ended up in a hospital intensive care unit with little hope of regaining your former way of life or even the ability to communicate with your loved ones? What kind of medical treatments would you choose for yourself? Would you want aggressive medical intervention?

Obviously, these are situations most people would rather not contemplate while they are healthy. And yet a number of high-profile legal cases have recently arisen from such circumstances. These ethical conflicts and controversies of end-of-life care underscore how difficult it can be for families and medical professionals to make life-and-death decisions for people who are no longer physically able to speak for themselves.

A living will, and its cousin, the health care proxy, are legal documents called advance directives, designed to help in such situations. They allow individuals to express their values and personal preferences for medical treatments in advance of a serious health crisis that leaves them unable to say what kind of medical care they want.

Advance care planning, however, is just the general term for the larger process of exploring such issues through personal reflection and conversations with those closest to you and with your doctor. Because of the controversial cases that have come up in the past, such as that of Terri Schiavo, states have passed laws defining the kinds of legal documents that could be recognized by medical professionals in a crisis.

However, most medical ethicists today say that a health care proxy document, formally appointing someone who could speak on your behalf when you are incapacitated, is more likely to be helpful in a crisis than a living will. This is because a living will, which spells out what kinds of treatment approaches you would want in some unknown future situation, may become obsolete and too restricting. A health care proxy is immediate and therefore more flexible.

More important, however, than either legal document is the process of considering what would matter most to you in such a crisis, and then sharing those reflections with the person you want to speak for you. Sound that person out; could they respect and honor your values?

A copy of your advance directive document, completed with the aim of capturing your considered values and preferences on paper, should also be given to your family doctor. Perhaps there are additional resources that your doctor can recommend to help with the process, such as referral to an advance care planning counselor or a palliative care consultation service based at your hospital or health system.

Experts insist that it is important to give your loved ones and physicians something to work with. If they have some understanding and paper record of your values of what ultimately would be most important to you in a tough situation that could prove to be an enormous relief to them and the best chance to ensure that your values and preferences actually get honored.