Medicine and Law in concert
To the Better End

Living Wills

The caduceus meets the scales of law

Fred Hansen
Winter '07
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Medical practice offers many options to prolong life, even beyond the sentient stages. Any body—even when brain-dead—can be kept alive mechanically. Indeed, this may be essential to preserving organs for donation to others.

You may have preferences as to what measures should be taken to keep you alive. To express these preferences clearly and give them legal force, you need to have a living will. Such a will is a document selecting various options. Among the available documents are those described below.

Please note: Just having the document is not enough. Relatives, doctors, and other medical staff must be told of the document. And even then someone with you at heart must be there to ensure that the living will provisions are carried out. I have personally witnessed a case where a living will was not conveyed along with a patient.

Center for Practical Bioethics


Caring Conversations logo
http://www.practicalbioethics.org

The Center for Practical Bioethics offers a comprehensive plan for communicating and refreshing your end-of-life desires: Caring Conversations. They identify four phases:
  • Reflect - on your personal experiences, values, desires and preferences.
  • Talk - to the person you are considering as your Agent.
  • Appoint - the person who will speak for you when you cannot speak for yourself using the Durable Power of Attorney for Healthcare Decisions form.
  • Act - by sharing your decisions about your healthcare preferences with family, friends, healthcare providers and clergy or attorneys if desired and reviewing your preferences on a regular basis.

Compassion and Choices


Compassion and Choices logo
http://www.compassionandchoices.org/ad/

Compassion and Choices has prepared Living Wills for all 50 states. It is best to download one from their site, but I have cached a copy for Pennsylvania.

Five Wishes cover sheet

Aging with Dignity is another organization working for better end-of-life experiences. Their version of a living will is Five Wishes. This document, they say, "looks to all of a person's needs: medical, personal, emotional and spiritual [and] also encourages discussing your wishes with your family and physician." Compassion and Choices has a link to Five Wishes with a caveat that it embodies a possibly undesirable sentence. Five Wishes has versions for all states, including Pennsylvania.


POLST


POLST document

 
http://www.ohsu.edu/polst/


Oregon Health & Science University has developed POLST, the Physician's Order for Life-Sustaining Treatment.  This model for the medical part of a living will has seen adoption by many states and localities, including Western Pennsylvania. It is a distinctive color and travels with the patient. (Unfortunately, the form and its color differs from state to state.)

Clicking the POLST image at the left will bring up a larger image. Its options illuminate the treatment choices available for any living will:

A CARDIOPULMONARY RESUSCITATION (CPR): Person has no pulse and is not breathing.
 empty check box Resuscitate/CPR
 empty check box Do Not Attempt Resuscitation (DNR/no CPR)

B MEDICAL INTERVENTIONS: Person has pulse and/or is breathing.
 empty check box Comfort Measures Only Use medication by any route, positioning, wound care and other measures to relieve pain and suffering. Use oxygen, suction and manual treatment of airway obstruction as needed for comfort. Do not transfer to hospital for life-sustaining treatment. Transfer if comfort needs cannot be met in current location.
empty check box Limited Additional Interventions Includes care described above. Use medical treatment, IV fluids and cardiac monitor as indicated. Do not use intubation, advanced airway interventions, or mechanical ventilation. Transfer to hospital if indicated. Avoid intensive care.
 empty check box Full Treatment Includes care described above. Use intubation, advanced airway interventions, mechanical ventilation, and cardioversion as indicated. Transfer to hospital if indicated. Includes intensive care.

C ANTIBIOTICS
 empty check box No antibiotics. Use other measures to relieve symptoms.
 empty check box Determine use or limitation of antibiotics when infection occurs.
 empty check box Use antibiotics if life can be prolonged.

D ARTIFICIALLY ADMINISTERED NUTRITION: Always offer food by mouth if feasible.
 empty check box No artificial nutrition by tube.
 empty check box Defined trial period of artificial nutrition by tube.
 empty check box Long-term artificial nutrition by tube.
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