March 29, 2005
Dr. Erik Steele, DO
The Terry Shiavo story has highlighted the importance of living wills as a way for patients to make clear their wishes about end of life care when they are unable to express themselves. A living will is a document in which a person makes choices about what they would want for care when terminally ill.
Who should have a living will? Every adult. Living wills are not just for the elderly, or those with conditions such as cancer. In fact, in some ways they are most important for those who do not seem likely to die any time soon, because it is these patients who often have not talked to anyone about death, who have not otherwise said what they would want if they ended up in a coma, and about whom end of life decisions can be especially painful for the family shattered by the sudden and unexpected illness.
A young husband should have one, for example, so that if he is injured in a car crash, his young wife could use the living will to help understand what he would want if his injuries left him in a permanent coma.
Some people are afraid that if they have a living will that they will not get all of the care they should, or that doctors will stop trying to save them during a serious illness. No one should have that worry. In fact, the living will is only used when the patient is in a condition that prevents them from expressing themselves. The patient with a head injury and on a breathing machine, for example, would be covered by the provisions of a living will, but the patient on a breathing machine who is conscious and competent can make their own decisions.
In addition, the provisions in a living will that cover care for terminal conditions – provisions such as withdrawing life support – do not get implemented until your physicians decide that you are terminally ill. That is traditionally defined as meaning your condition will almost certainly result in your death in the next six months. If you are not in a terminal condition, the provisions in your living will about withholding or withdrawing care do not apply.
Living wills are available from many sources, the best of which is often your local hospital. You can download a living will and information about living wills and how to complete them from the Eastern Maine Medical Center web site.
Finally, beyond filling out a living will, talk to your family and your physician about these end of life issues. When faced with these tough decisions for your care, if you have looked into a loved ones eyes and told them what you would want they will be able to follow your wishes more confidently than if those wishes are simply written down on a document.