A living will is your chance to stipulate exactly what medical intervention you receive at a time when you can’t communicate your wishes.
This is a legal document which is made in advance so that doctors and medical professionals can act according to your instructions.
It’s important to understand exactly what you need to put in your living will, how to make it legally binding and who needs sight of it.
In this article, we will take you through everything you need to know about the living will and how to make one.
Here’s a summary of what we’ll cover in this article:
- Why should you make a living will?
- Who can make a living Will?
- How do I decide what to include in my living will?
- How to make your living will legally binding
- Do I still need a Lasting Power of Attorney if I have a living will?
What is a living will?
Your living will is a directive of your wishes that should be used while you are still alive but unable to express yourself.
Many people make living wills to decide what medical interventions will take place later in their health journey and outline the treatment they do not wish to receive.
There may come a time, particularly if you are living with a terminal illness or a degenerative condition, that you cannot speak for yourself.
A living will (aka Advance Decision To Refuse Treatment) puts your wishes at the heart of the care you later receive.
Why should you make a living will?
The living will is designed to be a valuable piece of advance care planning, giving you control and peace of mind.
In a healthcare emergency or during end-of-life care, it can be tough for families to make critical decisions.
By making a living will, you take the responsibility out of their hands and into yours.
How is a living will different from a will?
The significant difference between a Living Will and a Will is that the former is made for use while you are still alive.
A traditional Will is actioned after a person dies and their property and financial assets, along with other end-of-life arrangements are dealt with.
The Living Will is all about decisions that need to be made while somebody is still alive but unable to speak for themselves.
Who can make a living will?
It’s vital to understand that you must have capacity when you make your living will.
Anybody over the age of 18 can make a living will as long as they are deemed to be mentally capable of making and understanding the process.
For the document to be legally binding, you must have the living will signed and witnessed.
Once this has been done, the living will takes effect, and anything you’ve stipulated will be legally binding.
How do I decide what to include in my living will?
People often make living wills when they’ve had a diagnosis or they are living with a long-term health condition.
It’s wise to speak to your doctor when making these decisions so they can run you through the likely scenarios that might come up for you.
Once you understand exactly what treatments could be offered, you can decide if you want them or if you want to refuse them.
What types of questions might you ask?
There are all kinds of health conditions you may want to discuss and the potential outcomes.
For example, you might want to ask, ‘what is end-of-life care? What treatment would I be most likely to be offered?
A doctor and other health professionals can run you through the risks and benefits of each type of treatment to give you a better understanding of what they entail.
The Four Main Types of Life-Sustaining Treatment
Many living wills will include directives on the following options for life-sustaining treatment:
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation, both invasive (intubation) and non-invasive (CPAP)
- Clinically assisted nutrition and hydration
- Antibiotics (for life-threatening infections)
A living will and CPR
If your heart stops beating or the rhythm becomes life-threateningly abnormal, medical teams may try to save a person’s life by using CPR.
This will be done by breathing air into the lungs and using chest compressions or by using a defibrillator.
The medical team may also use injections of medicine or artificial ventilation of the lungs.
Any person has the right to refuse CPR and to have a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) order in their medical records.
You may choose not to have CPR in the event of a life-threatening incident for several reasons.
For some people, CPR can result in complications, including fractured ribs, brain damage and damage to the liver and spleen.
Not all patients who receive CPR will benefit from it, for example, older adults who have chronic medical conditions or serious illnesses.
A living will and mechanical ventilation
If a person cannot breathe themselves or needs assistance to breathe safely, they may be placed on mechanical ventilation.
The machine pushes air down a tube that runs through your throat and into your lungs, a process called intubation.
Sometimes, doctors will sedate the patient as the intubation is uncomfortable and can cause distress.
If you need long-term mechanical ventilation, the team may perform a tracheotomy instead.
Refusing mechanical ventilation
Some patients do not want to be kept alive with mechanical ventilation.
By specifying this in a Living Will, you can let medical teams know this is your choice so they don’t administer this treatment.
If you have made clear wishes on CPR and mechanical ventilation treatment, it’s a good idea to let your loved ones know in advance so they’ll be prepared at the moment this comes up.
A living will and Pacemakers and ICDs
When a pacemaker is fitted, it’s done to help the patient’s heart keep beating regularly.
However, a pacemaker won’t necessarily save a person whose heart has stopped beating or whose heartbeat has become dangerously irregular.
Sometimes, patients have an implantable cardioverter-defibrillator (ICD), which shocks the heart if it stops beating regularly.
You can instruct – via the living will – for the ICD to be turned off at a time of your choosing.
A living will and clinically assisted nutrition and hydration
Another thing you may wish to include in your living will is instructions as to what happens when you cannot feed or hydrate yourself.
Patients who cannot eat or drink can be placed on a feeding tube or IV, which delivers the fluids or nutrients they need.
In the short term, a fluid tube is inserted into the nasal cavity, where it then runs down the oesophagus and into the stomach.
If the problems persist long-term, the tube can be surgically inserted into the stomach.
Refusing clinically assisted nutrition and hydration
Some might feel that being kept alive using assisted nutrition and hydration isn’t suitable for them.
They may feel that such an arrangement does not provide the meaningful kind of life that they wish to lead.
In your living will, you can state that you don’t wish to be kept alive using clinically assisted nutrition or hydration treatment.
How to make your Living Will legally binding
Once you have completed your living will and specified all your wishes, you need to have it witnessed.
Remember that the document must specify clearly what treatments you wish to refuse and in which circumstances you want to refuse them.
You must be over 18 years old and be judged to have mental capacity.
The living will must be signed by both you and a witness.
Where should I store my living will?
Here are a list of those who should hold a copy of your Living Will:
- Your GP surgery
- Your family and close friends
- Local hospital
- Local ambulance trust
Do I still need a Lasting Power of Attorney if I have a living will?
When people look into living wills they will often also ask, ‘what is Lasting Power of Attorney (LPA)’ in relation to health decisions.
An LPA is a person you appoint to make decisions for you when you don’t have the capacity to make them yourself.
You may wonder if you need an LPA if you already have a living will, but having both is a good idea.
Your LPA can refer to your living will, but you’ve also chosen them to act in your best interests in other scenarios.
Find out how to set up an LPA here.
How often should I review my living will?
The day you sign and have your living will witnessed may not be the final time you make the decisions about the treatment you wish to have or refuse.
Over time, opinions change, so reviewing your living will at least once a year is prudent to make sure it’s still what you want.
It’s also a good idea to look at it if you have any major life changes – for example, the death of a partner, dissolution of a marriage or house move.
You may also wish to review it if your health circumstances change.
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