ATLANTA – The holiday season – traditionally a time of family gatherings, gift-giving and celebrations – is a perfect time for family members to give the most loving gift of all, a living will. In 2002, a survey conducted by the Robert Wood Johnson Foundation indicated that 15 to 20 percent of Americans had living wills in place; following the Terri Schiavo case in 2005, 37 percent of Americans said they had a living will and 69 percent of those without a living will said the case made them think about getting one. Before you decide to undertake a living will, however, there are a number of factors to consider, say faculty at Mercer University.
"Giving our loved ones clear direction during a time of crisis is a gift of great love," says Elaine C. Grier, assistant professor of adult nursing at Mercer's Georgia Baptist College of Nursing. "As a critical care nurse, I have seen countless families suffer as they try to make hard decisions during a time when feelings of love, fear, grief and confusion abound. Unless we take the time to put our decisions in writing and share them with our loved ones, they will be flooded with doubt, indecision and guilt."
The first step is understanding what a living will is and is not. A living will is a legal document that clearly states your wishes about how you want to be cared for at the end of your life. A living will becomes activated when you are unable to state what you do or do not want to be done if your heartbeat and breathing stop, if you sustain severe brain damage from an accident or stroke, or if you are not conscious enough to understand your own health situation. Initial questions to consider include:
· Would you want cardiopulmonary resuscitation (CPR) if your heart suddenly stops?
· Would you want your breathing to be sustained on a breathing machine?
· If you are unable to eat or drink, would you want to be given nutrition by a feeding tube or intravenous (IV) fluids?
· Do you want your life to be prolonged if there is no reasonable probability of recovery?
Grier notes that although such questions are broad ones to consider, those considering establishing a living will should go one step further. She says general preferences about life-sustaining measures should be tempered by reviewing your own personal health history, and your written decisions should be based on your beliefs about accepting aggressive, lifesaving interventions which may restore you to your previous state of health. She cites the following scenarios:
· If you have asthma or emphysema and develop pneumonia (which could be successfully treated with a few days on a breathing machine and medication), would you want this treatment?
· If you have cancer and develop an infection from the side effects of chemotherapy, would you accept IV antibiotics if it would likely cure the infection?
· If you have severe and painful arthritis and have a car accident with massive bleeding, would you accept blood transfusions and surgery if it would likely return you to your pre-accident condition?
Should you decide you would like to receive lifesaving measures for any immediate crisis, your living will should include a statement that expresses your wishes to receive all lifesaving and supportive medical care should an emergency arise. If your condition fails to improve and you can no longer make your own decisions, then you should state you would like your living will to become active and be followed.
Another consideration when creating a living will is your decision about being an organ donor if a stroke or head injury leaves you brain dead. If you would want your heart, lungs, kidneys or other organs to be used to give another person a second chance for life, consider including a statement in your living will about your desire to be an organ donor and give permission to suspend the living will in order to preserve the viability of your organs if they can be used to improve the life of another person.
Grier also notes the importance of specifying a health care proxy, someone you trust to voice your medical wishes if you cannot speak for yourself. Your proxy should be someone younger than you who has no vested interest in your estate. Have a detailed conversation with this person about how you want to be treated under various circumstances, and give that person a copy of your living will.
Finally, tell your immediate family and close friends that you have a living will and where it is located. Review your living will once a year and modify it as your health status, values, beliefs, or wishes change. A living will and health care proxy should be in place as soon as a person turns 18 years of age and becomes an adult in the eyes of the law.
If you decide to implement a living will, forms are available at doctors' offices, hospitals, hospices and attorneys' offices. There are also many sites on the internet that will allow you to download forms, such as www.uslegalforms.com/livingwills/. This site allows you to click on the state in which you live to assure that specifics of the form are legally recognized in your state. Grier suggests making several copies of the blank form so that you can revise your living will without having to search for a new form and, once completed, having your signature notarized.
"Families are often divided in their beliefs about what their loved one would want to have done and intense conflict develops. Sometimes these relationships never heal," says Grier, who has advanced national certification in critical care nursing, and created Mercer's nursing course entitled "Caring in Times of Death, Dying, and Bereavement." "Providing clear direction in a living will takes the agony of decision-making away from those we love and provides assurance that they are granting our wishes. In a time of great turmoil, it will give them the gift of peace."
About Mercer University:
Founded in 1833, Mercer University is a dynamic and comprehensive center of undergraduate, graduate and professional education. The University has 7,300 students; 11 schools and colleges – liberal arts, law, pharmacy, medicine, business, engineering, education, theology, music, nursing and continuing and professional studies; major campuses in Macon and Atlanta; four regional academic centers across the state; a university press; teaching hospitals in Macon and Savannah; an educational partnership with Warner Robins Air Logistics Center in Warner Robins and Piedmont Healthcare in Atlanta; an engineering research center in Warner Robins; a performing arts center in Macon; and a NCAA Division I athletic program. For more information, visit www.mercer.edu.