Most living wills contain conditional wishes for different types of situations. For example, would certain painful treatments be tolerated if there were a chance for recovery? Or, would you refuse a feeding tube if it would be required indefinitely?
One of the most important aspects of writing a living will is deciding what to do if you are terminally ill. Some people don't want treatment that would extend life for a short period of time if their desired quality of life can't be restored. Others do want life extended for as long as possible, even if they may be in pain, unconscious or unable to communicate.
The various types of disability leave this portion of a living will more open to dispute as doctors, patients and family members frequently have different values and expectations. Additionally, some types of chronic ailments or permanent disabilities may be better dealt with than others, depending on the individual.
A person must decide which circumstances he or she wouldn't be able to endure and should specifically define these circumstances with three criteria in mind [ref]:
- type of injury or illness
- prognosis, especially with regards to permanence or irreversibility
These descriptions should be clear and medical in nature -- saying that you don't want to be in a "hopeless condition" is less clear than requesting not to be on a respirator.
It generally takes time to determine if someone will be permanently disabled or if some measure of recovery is possible. If someone experiences cardiac arrest and suffers a lack of oxygen to the brain, he or she will likely be brain damaged, especially if oxygen was cut off for an extended period of time. Still, in many cases it can take weeks of observation before a definitive prognosis can be made. Someone's condition may also change unexpectedly. That is why it's important not to specify time limits in a living will. Instead, base your requests for treatment (or withholding treatment) on prospects for recovery, the likelihood of permanent pain or discomfort and the judgments of your doctors.
When should I refuse treatment?
If you don't want certain treatments, it's important to identify those in a living will. Many living wills tell physicians to withhold "extraordinary care" or "life-sustaining or life-prolonging" treatments, but those terms can be unclear [ref]. Similarly, some living wills distinguish between "ordinary" and "extraordinary" care, but very complex or technologically advanced procedures can be common now. Keep the specific details in mind: a patient may not mind having a respirator if he has a collapsed lung and is expected to recover but would refuse one if he is in an irreversible coma.
Other reasons to refuse treatment may include:
- Not worth the pain or risk
- Will prolong life but in an uncomfortable state (i.e. long, burdensome dialysis sessions)
- If there's a procedure you know that you wouldn't want under any circumstances
Do Not Resuscitate (DNR) Order
A DNR Order prevents doctors and emergency personnel from giving you cardiopulmonary resuscitation (CPR). This order can be added to your medical record, stamped on a bracelet or kept close at hand in case paramedics come to your home, hospice, etc. A DNR Order is frequently used in tandem with a living will -- for example, if someone is terminally ill and doesn't want to be resuscitated should he or she stop breathing.
For an example of what a living will looks like, follow this link.