What Are Living Wills - Essay Example

A living will is a form of the advance medical directive that can be prepared by an individual in the presence of two witnesses. There is no requirement for the assistance of a lawyer while preparing a living will. In principle, a living will is a signed list of requirements relating to the provision of healthcare when the individual is incapacitated. The living will be very specific or very general, depending on one’s preferences, and can include information about an individual’s desires regarding services such as analgesia, antibiotics, hydration, blood transfusion, kidney dialysis, feeding, or mechanical respiration. The use of resuscitation techniques, such as cardiac resuscitation, can also be covered by a living will. The living will also specify the end-of-life care wishes. Moreover, the living will include a designation of a surrogate decision-maker, a person that will be responsible for making healthcare decisions should the individual become incapacitated. It is of paramount importance to ensure that the designated person and the doctor of an individual will honor all the instructions. A living will legislation covers a variety of topics, including procedures of executing the document, physician certification of illness, or immunity from civil and criminal liability. In general, the copy of the living will be given to those in charge of the medical care of an individual and maintained within his/her medical records. The living will come into effect when the individual becomes incapacitated and/or unable to make decisions regarding his or her own medical care (The U.S. Living Will Registry).

Documentation of living wills - federal regulations

The Patient Self-Determination Act of 1990 (PSDA) makes it mandatory for healthcare organizations to explain to the patients their legal rights regarding their own medical care as it corresponds to the existing state laws. The code of federal regulations also requires the healthcare providers to update the information provided to their patients within 90 days of the effective date of any changes in the State law. Moreover, if the healthcare provider can not implement the living will, a precise statement of limitation should be maintained. The statement of limitation has to name state legal authority that permits such an objection to the execution of a living will, and list both medical conditions and procedures that are affected by the objection. Upon admission to a hospital or nursing home, each patient needs to be asked about his/her living will or another form of an advance medical directive. The existence of the living will need to be clearly documented in the patient’s medical or care records. Federal law also requires healthcare providers to provide equal patient quality care irrespectively of whether the patient executed the living will or not (Electronic Code of Federal Regulations. Title 42 – Public Health).  Importantly, all these regulations affect also providers in religious non-medical healthcare organizations.

State law and documentation of living wills

Each state is required under PSDA to provide the description of state regulations to healthcare providers, who then need to ensure that written procedures and policies regarding living wills are established (Pozgar, 2007). The vast majority of states have endorsed legislation recognizing the right of a competent adult to prepare a living will. Law in many states provides statutory provisions or “natural death” acts that allow a living will to take effect if the patient is suffering from a terminal condition. The model of wording for living will document is provided by some state laws, suggesting that personal living wills should contain essentially the same information. Moreover, the majority of state laws specify that any physician may refuse to follow the directives of a living will but must make effort to transfer a patient to a physician that will be willing to execute the document. Interestingly, in some states, the living will is considered by law to be inapplicable while the patient is pregnant (Roach, Hoban, Broccolo, Roth and Blanchard, 2006). Most importantly, state law considers any interference with the proper use of directive forms, including unauthorized cancellation, falsification, or forgery, as well as withholding knowledge of revocation, as a criminal offense. Medical records need to clearly reflect the decision-making process, as this can be pivotal in the success or failure of legal claims.

Conclusions

A living will is the most widely available instrument for recording future healthcare-related decisions, and can be prepared by any competent adult concerned about medical treatment should he/she become incapacitated. Healthcare professionals are legally bound to respect one's wishes, as stated in the living will, within the clearly stated boundaries that should be unambiguously explained to the patients. Both federal and state laws regulated issues related to the execution of living wills by healthcare professionals.