It's never easy to ponder death, whether you're facing the demise of a loved one or the end of your own life. But taking some time to think and plan ahead for those final hours or days can be a future blessing for your family and others close to you. Most people want a say in all life's important decisions. The same should be true regarding decisions surrounding death, such as what kind of medical treatment you receive. But what if you're unable to make your decisions or wishes known? Say, for example, you are unconscious and can't speak or hear. Unless you have spoken with your loved ones and taken certain legal actions, there may be confusion and stress over what those decisions will be and who can make them for you.
Living wills and health care proxies — documents known as advance care directives — give you a voice in decisions about your medical care. Fewer than 30% of Americans have filled out advance directives. Yet without these documents, choices may be left up to a doctor or someone appointed by a judge — a person who may not know your values, beliefs, or preferences (that is, your health care philosophy). Or, a family member who doesn't know about your wishes may make decisions for you. For example, suppose a woman is unable to communicate because of a brain tumor and her only living relative is a brother with whom she hasn't spoken in 10 years. She and her best friend have talked frankly about her desire not to be put on life support or fed intravenously. Legally, her brother may get to make such decisions, although clearly he's not the person most familiar with her desires. But if that woman had taken the simple steps to legally name her friend as her health care agent, she would have lived her last days as she wanted.
You can hope your health will be sound for the rest of your life, but there are no guarantees. So take the time to learn about and complete the necessary forms — and the sooner the better. Even if you're in perfect health, you never know when life may throw a medical crisis your way. That's why everyone over age 18 should have a living will or health care proxy. As you get older, this becomes more crucial; half of hospital stays and 80% of deaths involve people over age 65.
Advance care directives enable you to choose someone to make health care decisions for you if you are unable to do so, let you specify what kinds of treatment or goals of treatment you'd like in different circumstances, and allow a consistent plan to emerge over all by providing a base upon which to build your health care philosophy. Some people worry that by filling out these documents, they're giving up control over their medical treatment. But in reality, advance care directives help you gain control over your health care. As long as you are able to make and communicate your decisions, your word supersedes anything you've written or said to others. It's only when you're unconscious or too ill to make your wishes known that any type of advance care directive goes into effect. If your medical condition improves and you can once again make and express your decisions, your oral statements again take precedence.
Although advance care directives are important forms to complete, they're not difficult to understand, and you don't need a lawyer's help. This report will explain the process, give you tips on talking about this difficult subject, and provide you with most of the forms you need. Keep in mind, though, that forms may vary from state to state. In those cases, we provide you with information on how to obtain the right document.
Form 3: Generic Living Will
Download a PDF version of this form at www.health.harvard.edu/downloads/LWforms.pdf
If you aren't appointing a health care agent, it's important to get a state-specific living will form so you can be sure the document will be legal in your state. You can use this Generic Living Will until your state-specific one arrives. If you are appointing an agent, you can still fill out this generic form and give it to him or her to make sure your wishes are understood. In the following form, "life-support treatment" refers to medications, surgeries, blood transfusions, mechanical ventilation, artificial nutrition and hydration, defibrillation, cardiopulmonary resuscitation, and anything else meant to keep you alive but that will not cure your condition.
Situation A: If more than one doctor says that I will probably die within a short period of time, and life-support treatment will only delay my death, I (choose one)
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want to have any life-support treatment offered
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want to have life-support treatment, limited to (check off and initial those you would want)
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do not want life-support treatment
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do not want life-support treatment; if it has been started, I want it stopped
Notes: __________________________________________________
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Situation B: If I have permanent and severe brain damage, with no known hope of recovery (as determined by more than one doctor), and life-support treatment would only delay my death, I (choose one)
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want to have any life-support treatment offered
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want to have life-support treatment, limited to (check off and initial those you would want)
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do not want life-support treatment
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do not want life-support treatment; if it has been started, I want it stopped
Notes: __________________________________________________
_______________________________________________________
Situation C: If I am in a coma and more than one doctor says that I am not expected to wake up or recover, that I have brain damage, and that life-support treatment would only delay my death, I (choose one)
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want to have any life-support treatment offered
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want to have life-support treatment, limited to (check off and initial those you would want)
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do not want life-support treatment
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do not want life-support treatment; if it has been started, I want it stopped
Notes: __________________________________________________
_______________________________________________________
Situation D: When I have gotten to the "end-stage condition," where my health is so poor that I cannot mentally or physically care for myself and life support will only prolong my death, I (choose one)
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want to have any life-support treatment offered
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want to have life-support treatment, limited to (check off and initial those you would want)
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do not want life-support treatment
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do not want life-support treatment; if it has been started, I want it stopped
Notes: __________________________________________________
_______________________________________________________
Other: If there is another condition for which I want to specify my desired treatment, I have done so below.
_______________________________________________________
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Religious beliefs (optional): Below, I have written out any religious beliefs that should guide doctors or others responsible for making decisions about my health care.
_______________________________________________________
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Signature _______________________________________________
Printed name ___________________________ Date ____________