To the Better End - Living Wills

	To the Better End Living Wills The caduceus meets the scales of law	Fred Hansen Winter '07

Physpics

My own experiences

State reports

Organizations

Living wills

Metaphysics

Discussion topics

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.

Compassion and Choices

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.

Aging with Dignity

http://www.agingwithdignity.org/5wishes.html

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." You have to order it from them to get a printed copy, but you can view it online. It is valid for most states, including Pennsylvania.

POLST		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. Resuscitate/CPR Do Not Attempt Resuscitation (DNR/no CPR) B MEDICAL INTERVENTIONS: Person has pulse and/or is breathing. 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. 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. 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 No antibiotics. Use other measures to relieve symptoms. Determine use or limitation of antibiotics when infection occurs. Use antibiotics if life can be prolonged. D ARTIFICIALLY ADMINISTERED NUTRITION: Always offer food by mouth if feasible. No artificial nutrition by tube. Defined trial period of artificial nutrition by tube. Long-term artificial nutrition by tube.

23 Aug 2007 05:05 PM

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