What is an Advance Directive, or a Living Will, and How Do They Work?

Posted on: April 27th, 2012
An Advance Directive (also known as a Living Will) is a legal document that communicates your desires about future medical treatments, or the lack thereof, when you are unable to communicate on your behalf. Ordinarily, this document outlines your desires about whether you do or do not want life support in the event that is the only method that will sustain your life.

     This document, along with a Healthcare Power of Attorney and a HIPAA Authorization, is a very important document to have. It is a loving document because it can help alleviate some of the stress placed on your loved ones if they have to determine, on their own, whether or not life sustaining treatments, as defined below, should be discontinued. This document allows you to communicate your desires about such treatments in advance and take some of the burden off you family and loved ones.   

It is important to note, that your doctor must follow his or her Hippocratic oath. This means they will use whatever methods available to restore you to good health. Because modern medicine is able to keep your body “alive” even after your body is unable to do so on its own, it is a good idea to provide your doctors and loved ones with your own desires about life sustaining treatments. Thus the need for this document.

     In Texas, you will need to determine whether or not you want “life sustaining treatments” in two situations:

  1. If you are suffering from a terminal condition; and
  2. If you are suffering from an irreversible condition.

     Life sustaining treatment is defined as “treatment that, based on reasonable medical judgment, sustains the life of a patient and without which the patient will die. The term includes both life-sustaining medications and artificial life support such as mechanical breathing machines, kidney dialysis treatment, and artificial hydration and nutrition. The term does not include the administration of pain management medication, the performance of a medical procedure necessary to provide comfort care, or any other medical care provided to alleviate a patient’s pain.”

     A terminable condition is defined as “an incurable condition caused by injury, disease, or illness that according to reasonable medical judgment will produce death within six months, even with available life-sustaining treatment provided in accordance with the prevailing standard of medical care.”

     An irreversible condition is defined as “a condition, injury, or illness:

  1.       that may be treated, but is never cured or eliminated;
  2.       that leaves a person unable to care for or make decisions for the person’s own self; and
  3.      that, without life-sustaining treatment provided in accordance with the prevailing standard of medical care, is fatal.”

     For illustration purposes, many Living Will documents offer the following explanation:

     Many serious illnesses such as cancer, failure of major organs (kidney, heart, liver, or lung), and serious brain disease such as Alzheimer’s dementia may be considered irreversible early on. There is no cure, but the patient may be kept alive for prolonged periods of time if the patient receives life-sustaining treatments. Late in the course of the same illness, the disease may be considered terminal when, even with treatment, the patient is expected to die. You may wish to consider which burdens of treatment you would be willing to accept in an effort to achieve a particular outcome. This is a very personal decision that you may wish to discuss with your physician, family, or other important persons in your life.

     A common form used in Texas looks like this:

     Terminal Condition: If, in the judgment of my physician, I am suffering with a terminal condition from which I am expected to die within six months, even with available life-sustaining treatment provided in accordance with prevailing standards of medical care:

     Option 1 I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR

     Option 2 I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)

     Irreversible Condition: If, in the judgment of my physician, I am suffering with an irreversible condition so that I cannot care for myself or make decisions for myself and am expected to die without life-sustaining treatment provided in accordance with prevailing standards of care:

     Option 1 I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR

     Option 2 I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)

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