A living will is a medical care declaration which explicitly records an individual’s desires, preferences and wishes regarding treatment whenever such wishes cannot be individually communicated due to enduring unconsciousness or terminal sickness. It is some legal document which permits an individual to announce their wishes pertaining to life-prolonging therapies. Original living wills assisted persons who desired to face natural deaths unattended though man-made life sustenance as well as other health methods. As such documents became increasingly accepted and extensively accessible as per local regulations, other medical care worries such as resuscitation, tube nourishment, as well as donation of organs, came to be included (Freer, 1994). Living wills may include wide-ranging non-legally binding statements regarding a person’s wishes, as well as particular rejections of therapy referred to as ‘advance directives’ or ‘advanced decisions’. Living wills should avoid employing ambiguous terminologies, like ‘heroic’ or ‘extraordinary’, if the connotation of such terminologies is not provided in the living will.
Living wills extend the consent principle which stipulates that patients should concur with whatever health intervention prior to the execution by doctors. Living wills uphold individual control to numerous individuals as well as simplify families’ decision-making burdens.
Forty-two US states plus the District of Columbia possess living will regulations which make properly implemented living wills legally obligatory. Within states with no relevant statues, living wills remain to be unambiguous expressions regarding patients’ desires. Living will regulations stipulate that persons be legally capable in order to carry out such wills and that the wills be overseen by a minimum of one non-stakeholder individual. In the event that an individual having a legally binding living will becomes fatally sick, the physician providing healthcare plus another physician should certify through writing the non-existence of rational hope for progress regarding patients’ situation and that death is inevitable owing to some incurable ailment, injury or illness.
After such certification, doctors are compelled to abide by the directives found within the living wills. Typically, this implies that patients do not favor whatever medical processes which only serve to extend life, however not avoiding the process of dying. Thus, in case a patient cannot breathe, doctors are barred from connecting such patients to respirators (Hanley, 2009). Patients may direct in their living wills that they object tube-feeding in case they cannot swallow food, or that they object resuscitation in case their hearts stop beating.
For instance, in case some individual sustains life-threatening hurt, or gets incapacitated owing to some fatal sickness, the choices regarding the patient’s health remain the patient’s provided that some living will exists. In the absence of such a document, close relatives, spouses as well as other persons have the responsibility of making choices (http://www.answers.com/topic/living-will).
Drafting of a living will should be carefully thought out, as well as be discussed with patients close relatives plus medical care professionals. Patients are advised to dialogue regarding their desires long before health therapy becomes necessary, since living wills as well involve the patient’s close friends and family, who are required to help in implementing the living will. It ought to be investigated for the locality whereby patients are most probable to obtain health care.
A living will may be extremely extensive or extremely narrow text, depending on the patient’s wishes. It includes a patient’s statement in written form regarding what they desire in case they encounter some serious illness or accident. It primarily is addressed to health personnel regarding the kind of medical attention patients desire to be subjected to, or object to them, in case of incapacitation or fatal illness.
The living will type proposed by the act includes particular reference to several diverse life-sustaining procedure types that could be rejected including: cardiac revival; pipe hydration or tube nourishment; motorized respiration (usage of respirators); blood plus blood product transfusion; kidney dialysis; all-encompassing diagnostics or surgery; drug administration; organ and tissue donation; surgery; and antibiotics (http://www.streetdirectory.com/travel_guide/163562/estate_planning/living_wills_why_are_they_so_important.html).
A living will spells out a person’s feelings regarding particular medical therapies as well as interventions. It offers physicians and close family members some idea regarding the care one would prefer in case they are unable to verbally converse. It acts as some guide; however, it does not elucidate every possible circumstance.
Living wills may not be regarded as viable unless the declarant becomes incapacitated, because until such a time the declarant can speak out regarding the therapies they prefer as well as those they do not prefer. For a living will to be declared effective, the declarant doctor’s certification as well as documentation by a different physician, confirming that the declarant suffers from some terminal sickness or is eternally unconscious, is required. This implies that in case the declarant has some heart failure, for instance, but does not have any fatal sickness or they are not enduringly unconscious, living wills are not effective. The declarant would as well be subjected to resuscitation, regardless of whether or not their living wills direct that life extending procedures should not be administered on them. Living wills only apply when the declaratant’s eventual recovery seems hopeless (Rebecca, 2008).
A different living will form approves a particular kind of medical care substitute or authority of a legal representative, whereby someone gets nominated by the author to decide in their stead when the individual is incapacitated. Persons could also have both the two forms, since this grants optimally comprehensive instructions pertaining to their therapy.
Universal written declaration, also referred to as ‘advance statement’, may specify the therapies an individual would or would not prefer to get in case of future mental incapacitation. Such statements are not legally compulsory; however medical care experts should consider them when choosing a strategy. Friends and family may utilize such statements as proof of a person’s wishes. An individual may as well announce their viewpoints orally, for instance, by discussing therapies with medical care experts.
Information included in living wills include: therapies persons would be content to get as well as overriding circumstances; therapies persons would never prefer, regardless of the severity of their illness; therapies persons would wish not to get as well as the prevailing circumstances; and individuals to be consulted regarding a persons therapy whenever decisions are to be arrived at.
A particular rejection of therapy may also be included in the statement, and this has some varied legal standing. Persons drafting advance declarations may also stipulate that they prefer not to have particular therapies administered unto them, however would permit for fresh therapies. This provides for accommodation of new treatments or drugs that are introduced with time. The advance declaration should have date, address plus signatures of the persons drafting it. Persons may also state that they understand their decisions and have the competence to make such choices. Some witness signs the declaration confirming that the author had competence when they wrote the declaration
Persons may as well draw living wills if mental problems are detected in them, provided that they comprehend the ramifications of their actions. One is only needed to have the competence to undertake the decisions under consideration, and not essentially different decisions.
Persons ought to document their preferences and provide details like: why they choose to reject or accept the therapy they have specified; the persons understanding regarding the therapy they accept of reject; and the reason why persons are making such decisions.
Living wills are included in a person’s health notes to facilitate their accessibility and compliance with in case of emergencies. Persons may forward copies to their physicians, close relatives as well as to any health facility that may be treating the individual. In the event that living wills are in verbal form, persons should ensure that friends and close family members understand the will. Upon admission into nursing facilities or hospitals, doctors and other health professionals are required by law to inquire if patients hold living wills. Such living will text should be included in patients’ health records together with other health-related documents like the health authority of attorney statement (Rebecca, 2008). Such a document acts as a declaration of intent regarding the declarant and may prove extremely vital to close relatives, medical care professionals as well as the declarant proxy in the event of very disconcerting and distressful times.
Medical care professionals as well as doctors ought to inform declarants in case they are conscientiously unable to abide by patients’ wishes or in case the health professionals’ policies stop them from abiding by patients’ wishes. In case a patient is incompetent at the time of admission to some medical facility and if someone to make choices on behalf of such a patient is named in the patient’s living will, such a personality should be notified in the event the desires specified in the living will are not to be satisfied (Freer, 1994). In the event that the patient has not specified anyone within their living wills, their family, other delegate or guardian should be notified that the patient’s wishes are not to be satisfied.
Persons may regularly revise their living wills to ensure that they are content with the documents especially if their circumstances changes. Persons could cancel or change their living wills in case they are capable of rational thought and offer clear explanations regarding their preferences. Ideally, individuals document their preferences and do away with previous versions (http://www.direct.gov.uk/en/Governmentcitizensandrights/Death/Preparation/DG_10029429).
Living wills may as well include concerns regarding pain therapy, water and food. Majority of states acknowledge that discomfort and pain relief are processes desired by majority of patients and hence such are not regarded as being life-extending therapies. In particular states, though, water and food could be regarded as being life-extending, and the deliberation to reject them could be within the patient’s liberties to reject.
Living wills, in particular states referred to as declarations or instruction to doctors, do not need surrogates (appointed persons) to carry out choices for patients. Majority of states include such kinds of directives within their health durable power of attorney outlines. Not very state, however, acknowledges detached living wills as being legally viable, for instance California.
Living wills typically offer specific instructions regarding treatment strategies to be adopted by caregivers and medical care providers. Sometimes living wills could forbid usage of different types of taxing medical therapy. It could as well be utilized to issue wishes regarding the usage or giving up of water and food, if provided through pipes or different medial apparatus. The document is viable only when the person is incapable of giving informed refusal or consent, that is, individual medical care directives owing to incapability. Living wills may be highly precise or extremely general (http://www.lectlaw.com/filesh/qfl01.htm).
More precise living wills could include information pertaining to a persons wish for services like analgesia for pain reprieve, antibiotics, feeding, hydration as well as usage of cardiopulmonary revival or ventilators.
Major shortfalls were soon noticed after living wills became better understood. Majority of living wills seemed to have limited scope; they usually did not tackle presenting needs and problems. In addition, numerous persons drew out such wills in forms that could depict disagreement with proper health practice. Eventually, living wills were concluded as being inadequate to tackle numerous medical care choices. Therefore, medical care substitute nomination or health powers of a legal representative, sometimes referred to as ‘second generation advance directives’, were developed.
Since living wills involve complex medical concerns, consultations with physicians could assist in clarifying various treatment modes as well as help in undertaking living will choices. Living wills may not be regarded as binding if patients are not medically established as being terminally sick or in enduring vegetative conditions, and hence not able to voice health preferences (Hanley, 2009).
Medical care substitutes and durable powers of legal representative for medical care were developed and incorporated into lat to allow a persons to nominate another individual to undertake medical care choices on their behalf in the event that they are unable to announce their wishes. The nominated medical care substitute essentially has equal rights to refuse or request for therapy as the person would possess incase they still are competent to make and communicate medical care choices. Such provisions have the advantage of enabling the nominated representative to make instantaneous choices in real circumstances, unlike advance choices made in imaginary circumstances, as provided in living wills (http://www.direct.gov.uk/en/Governmentcitizensandrights/Death/Preparation/DG_10029429).
Durable powers of attorney may permit the nominated representative (attorney-in-fact) to employ their own opinion or instruct them to abide by the directives of the living will. Living wills could as well specify some substitute to aid in enforcing its conditions. Durable powers of attorney could be applied whenever the persons granting such powers are unable to make own medical care choices, regardless of whether the person granting the powers is terminally sick and has enduring unconsciousness or not.
As per the regulations of different states, living wills are viable in limited circumstances when individuals become “qualified patients”. Treatment may generally be withdrawn or refused as per the living will only if the individual satisfies qualifying conditions like: medical forecast of some fatal condition, unrelenting vegetative or enduringly unconscious; incapability to undertake medical care choices; and not in pregnancy (http://www.answers.com/topic/living-will).
Usually, living will regulations cater for therapies or processes that could be rejected in case patients attain qualified statuses. Procedures which could be rejected are usually classified as ‘life-prolonging’, death-delaying’ or ‘life-sustaining’.
In the event that living wills refer to particular treatments, they ought to specify whether they apply solely to only such therapies, or whether such wills include, but are but restricted, to the particular therapies listed. Because forecasting or inclusion of applicable therapies is impractical, majority of living wills comprise but are not restricted to the particular therapies explained within such declarations (Freer, 1994). The inclusion of general remarks of intention as principles, like whether therapy ought to be discontinued if expensive, physically invasive, hard to manage or painful, within living wills is as well useful.
State regulations usually have forms stipulating the required or recommended living components. Particular state regulations have representations of living wills which could be utilized, whereas various other local laws offer forms for which they expect significant compliance. In case an individual finds such provided forms too restrictive or having excluded vital issues, such persons could slot in additional instructions.
Persons should sign their living wills and in the event that declarants prove physically incapable of signing such documents, state regulations could permit a different individual to sign such at the instructions of the declarant. State regulations regarding to witnessing ought to be adhered to since Restrictions pertaining to qualifications of living will witnesses may exist. Usually state regulations require a minimum of two grown up witnesses to observe living will signing; one or all two witnesses should not be stakeholders to that document, that is, unrelated by marriage or blood, not would-be beneficiaries of a section of the estate, not declarant’s medical care physician or not accountable for declarant’s medical care expenses. Particular states as well require for the notarization of living wills.
Living wills are binding unless they are cancelled through physical destruction; declarants declare that they are revoking them or when declarants write annulment documents. Living wills do not generally expire; however fresh living wills may be required in case declarants’ desires change or with the introduction of new laws.
Persons ought to dialogue with their physicians or other medical care experts regarding living wills before developing such documents since such professionals may educate persons regarding different medical care choices and procedures that could be needed and ought to be addressed by living wills. Such a dialogue will also provide insight as to whether the health professional is willing to abide by the stipulations found in the living will or holds particular ethical, religious or moral objections to such
Majority of state regulations call for the provider or physician to include persons’ living wills within patients’ health records. Persons also ought to place copies of their living wills together with vital documents as well as statements in wallets regarding the reality and placement of their living wills. Particular states run registries for living wills whereby citizens file their living wills.
Living will regulations generally offer some kind of immunity to medical care professionals in case they abide by the directives provided in a living will. Such immunity could be against criminal responsibility, unprofessional behavior findings or civil accountability.
State regulations usually incorporate mention of homicide, euthanasia and suicide and clearly state that ax choice to reject therapies should not be regarded as suicide nor is abiding by such a choice regarded as an aided homicide or suicide (http://wills-probate.lawyers.com/living-wills/).
Living wills ought to be written on uniform forms, either or not aided by some attorney. Such a document could be nullified orally or through writing, by either the declarant or by some nominated substitute at whatever time. In case the declarant has not specified in their living will some specific treatment element or withdrawal of treatment, such a component is then excluded. Living wills ought to be as detailed and specific as they possibly can.
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Rebecca, B. (2008). What is a living will? Retrieved 27th may 2009 from http://www.alllaw.com/articles/wills_and_trusts/article7.asp
Living wills, why are they so important? Retrieved on 27th may 2009 from http://www.streetdirectory.com/travel_guide/163562/estate_planning/living_wills_why_are_they_so_important.html