WHY NOT MAKE A LIVING WILL?

For almost 15 years now any patient entering hospital in the US has been asked to register their views on resuscitation. Their wishes can then be taken into account should an emergency situation arise.The demand for Living Wills or Advance Decisions as they are now called has trebled in the UK in the last three years. The British Medical Association, Royal College of Nursing and the Government have called for a move towards the American Style of consent forms in UK hospitals and these are now available in some health authorities.

Of course this is a taboo subject and one that people shy away from thinking about, let alone discussing. Surely though; if you do have preferences about your end of life care would it not be kinder to the relatives you leave behind to make a decision whilst you still can?

A living will lets you specify decisions about artificial life preserving in advance. It not only ensures your wishes will be heard, but also protects your loved ones from having to make difficult, deeply personal choices for you.

A Living Will is a legally binding option for people wishing to keep control over future medical decisions. It is nothing whatsoever to do with financial affairs.

It is your chance to make sure that you are not kept alive in circumstances which you would find intolerable.

Because of the seriousness of this decision and its potential result, witnesses must verify that a living will states the maker’s true intentions. Also, the witnesses must not have any interest in your estate,; they cannot be beneficiaries in your Will.

To make a Living Will you need to be:

• Mentally able and in no mental distress

• Over 18

• Not pressured or influenced by anyone to make the decision

• Fully informed at the time of making about the consequences and nature of the will

• In full understanding that the will must apply to all situations or circumstances which arise later

Living wills and mental capacity

You can still make a living will if you're diagnosed with a mental illness, as long as you can show that you understand what you're doing and the implications and consequences of your action. You only need to be competent to make this decision and not necessarily competent to make other decisions.

It is advisable to put your wishes in writing and explain:

• why you've made your decision about how you do/don't want to be treated

• what you understand about the treatment you're agreeing to or refusing

• why you're making these decisions now

The Living Will can be as detailed or as simple as you wish; it can specify that certain medications be avoided or that tube feeding or resuscitation not be carried out.

On the other hand, it may say that all life preserving treatment should be tried, irrespective of the chance of a successful outcome. However, unlike a refusal of treatment, a request for every possible therapy is not legally binding. The medical team does not have to follow your instructions but at least they will know that the person wants every possible opportunity to recover even if the chances are slim.

Statements and Directives

There are two ways of documenting your wishes - Advance Statements and Advance Directives.

Advance statements are not totally legally binding, but they must be considered by doctors when deciding what action to take. An advance statement could give a guide to health professionals about what sorts of treatments you would be happy to receive and those you would not. You can also specify if you would like medical staff to contact their Health Care Proxy before they make a decision. This may be a close friend or member of the family who will make decisions on their loved one's behalf, should the need arise.

If you have been asked to be a Health Care Proxy, you thoroughly discuss your loved one's preferences with regard to future treatment. It is also worthwhile writing down exactly what those preferences are and keeping the details in a safe place for referral to if the need arises.

There is no legally binding form that an advance statement must take, but there are a few guidelines that it is recommended you follow. Most importantly, you must sign and date the document, and include your name and address. Also, you should state at either the beginning or the end of the statement that you are fully aware of what you are doing, and capable of making the decisions outlined. You should also get a witness sign the document, to testify that this is the case.

Verbal Instructions

A verbal expression of your wishes must also be taken into account, but is more difficult to prove after the event.

Advance Directives

If there are specific treatments that you wish to refuse if you lose your mental capacity, you can make these explicit instructions in advance directives. They are instructions to the medical professional and exercise your legal right to accept or refuse treatment. As with advance statements, there is no detailed legal format for these documents. However and advance statement should always be in writing, and witnessed. If you make one of these directives you may wish to think about the possibility of new medical advances and take these into account when you express your instructions. An advance directive is legally binding, and must always be adhered to by health professionals.

Draft Living Will - UK

This Video gives good advice for people living in the US - beware though some of it is quite flippant!

The cost of an Advance Decision varies. In the UK to prepare one can cost anything from £0 via a website such as compassionindying.org.uk to over £100 if prepared by a firm of solicitors.

© Susan Bailey 2008 All Rights Reserved