A living will puts some of your most personal healthcare choices into words. Knowing that it exists for that purpose is only the beginning. What does the document actually say? When would its instructions be used? And does declining one type of treatment mean that other medical care would stop, too?
Those questions become important when you start looking beyond the basic definition of a living will and at how the document is intended to work.
The details of a living will vary by state, including how you can document your wishes for future medical care. Understanding their instructions can help you make choices that more accurately reflect what you would want if the document is ever needed.
What Is a Living Will?
A living will is a legal document used to record certain healthcare instructions for circumstances in which you cannot make or communicate those decisions yourself.
Despite the similar name, it is not the same as a last will and testament. A last will and testament deals with matters that arise after death, including the distribution of property. A living will deals with medical care during your lifetime.
The terminology and legal requirements vary from state to state. The circumstances that make a living will applicable can vary as well, which makes it important to understand the particular document you are completing.
Rather than viewing a living will as a general statement about whether you do or do not want medical treatment, it is more useful to think of it as a set of instructions for particular circumstances.
A Living Will Is About More Than Saying “Yes” or “No” to Treatment
Medical treatment decisions are rarely as simple as choosing whether you want treatment at all.
A person may feel very differently about a medical intervention depending on why it is being used, how long it is expected to be needed, and what doctors believe it can accomplish.
For example, there can be an important difference between a treatment used temporarily while someone recovers and the same intervention used when there is little expectation that the underlying condition will improve.
That context is part of what makes completing a living will a thoughtful process rather than simply a matter of checking boxes.
The question is not necessarily, “Would I ever want this treatment?” It may be closer to, “Under what circumstances would I want this treatment, and under what circumstances would I not?”
The options available for expressing those preferences depend on the form and applicable state law.
When Would the Instructions in a Living Will Be Used?
Completing a living will does not mean its instructions apply to every illness, injury, hospitalization, or medical procedure.
If you are capable of understanding your medical situation and communicating your choices, you make your own healthcare decisions. Your living will is intended to provide instructions when you cannot do that yourself and the circumstances required for the document to apply have been met.
Those requirements can differ by state and by document. A living will may use particular medical terms or identify specific conditions in which its instructions become relevant.
This is an important reason to read the document carefully. Terms that sound straightforward in everyday conversation may have a more specific meaning in the document or under applicable law.
Understanding when your instructions apply is just as important as deciding what those instructions should be.
Declining a Treatment Does Not Necessarily Mean Declining All Care
This is an important distinction that can sometimes get lost when people talk about living wills.
Choosing not to receive a particular life-sustaining intervention under certain circumstances does not necessarily mean choosing to receive no medical care at all.
There may still be care directed toward comfort, symptom management, pain relief, and other needs.
The particular care available will depend on the medical circumstances and the patient’s wishes.
That distinction matters because phrases such as “I don’t want extraordinary measures” can sound clear in casual conversation but leave significant questions unanswered.
What measures? Under what medical circumstances? For how long? What if a treatment could help someone recover from a temporary condition?
A living will provides an opportunity to address healthcare wishes more deliberately than a general statement made in conversation.
What Happens If the Medical Situation Does Not Fit Neatly Into the Document?
Even a carefully completed living will may not answer every medical question that arises. A future situation could involve a treatment, condition, or set of circumstances that you did not specifically address when you completed the document.
That does not mean the document has failed. Your written instructions can still provide important guidance about your wishes, while other parts of your advance care plan may help address decisions that were not specifically covered.
This is one reason it is also important to talk about your wishes with the person you have chosen to make healthcare decisions for you. Understanding the reasoning behind your choices may help that person make decisions in circumstances you could not have anticipated.
Can You Be Too Specific?
A living will should provide meaningful guidance, but trying to account for every possible medical scenario is unrealistic.
Instead of focusing only on individual treatments, consider the circumstances that might affect your choices. Would your wishes change depending on the likelihood of recovery? Would you feel differently about a treatment that was expected to be temporary rather than ongoing? What would you want the treatment to accomplish?
Thinking about those questions can give your written instructions useful context without requiring you to predict every possible situation.
MedlinePlus recommends understanding your treatment options when considering future healthcare decisions. Your healthcare provider can help explain medical terminology, treatment options, and possible outcomes so you can make informed choices about your care. An estate planning attorney can help you understand your state’s requirements, the language used in the document, and how your living will works with the other parts of your advance care plan.
What If You Change Your Mind While You Can Still Communicate?
A living will is intended to speak for you when you cannot speak for yourself. It is not meant to replace the decisions you are capable of making in the present.
Suppose your living will contains an instruction about a particular type of treatment, but years later you are facing an actual medical decision and feel differently. If you have decision-making capacity, you can communicate your current wishes to your healthcare providers.
Your present healthcare decisions are not simply ignored because you previously completed a living will.
This is another reason it is useful to understand the role of the document. A living will provides advance instructions for a future situation in which you cannot make or communicate the decision. It does not take away your ability to participate in your own healthcare while you can do so.
If your views have changed more permanently, however, it may be time to update the document so that your written instructions and current preferences do not conflict.
Why the Words You Use Matter
Statements about end-of-life care often sound clearer in conversation than they really are.
Someone might say, “I don’t want to be kept alive by machines,” or “I wouldn’t want heroic measures.”
Those statements may communicate a general feeling, but they can leave important questions unanswered when an actual medical decision has to be made.
What does “kept alive by machines” mean to that particular person? Would the answer change if the treatment were expected to be temporary? What does “heroic” mean in a specific medical situation?
A living will provides a more formal way to document healthcare choices within the framework provided by applicable law.
The process of completing one can therefore be valuable in itself. It requires you to move beyond broad phrases and consider what you actually mean when you talk about the medical care you would or would not want.
Understanding the Document Before You Sign It
A living will may eventually be relied upon at a time when you cannot explain what you intended. That makes understanding it at the time you complete it especially important.
Read the document carefully. Pay attention to the circumstances in which the instructions apply and the choices you are being asked to make. Ask questions if medical or legal terminology is unclear.
Most importantly, make sure the choices recorded in the document are actually yours.
A living will is designed to preserve your voice when you cannot communicate your healthcare decisions directly. The more carefully you consider what the document says and when those instructions apply, the more accurately it can reflect the care you would want.
MedlinePlus, “Advance care directives“. Read the full article here.