What Is the Difference Between a Living Will & an Advance Directive?
A living will is a type of advance directive. Generally, an advance directive is a legal document that stipulates a person's wishes regarding end-of-life health care.
Advance directives can be divided into two basic categories: living wills and durable power of attorney documents. Living wills establish a person's specific desires for end-of-life treatment, either requesting or refusing certain procedures. Durable power of attorney documents legally grant a designated person, usually a family member, the right to make those decisions in the event an individual is unable to do so. The two documents are not mutually exclusive, and, in fact, both can be prepared in order to provide the greatest amount of clarity about someone's end-of-life wishes.
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Advance Directives: Background
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Both types of advance directives are intended to create a legal record of an individual's opinions on end-of-life treatment at a time when the individual is of sound mind and body, therefore enabling doctors to honor those wishes even if the individual is no longer physically or mentally able to express them.
The documents can also serve to avoid confusion or additional hardship for family and friends who are otherwise asked to make medical decisions for a loved one receiving end-of-life treatment without necessarily knowing what he might have wanted.
Living Will
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A living will relates an individual's wishes. The main objective of a living will is to express an individual's views on treatment intended to extend life in the case of a terminal illness. In such cases, patients can either accept or refuse care, and living wills usually set forth specific desires on treatments such as the use of dialysis or breathing machines, the introduction of feeding tubes and whether or not doctors should attempt to resuscitate the patient if she is no longer breathing or no longer has a pulse.
Living wills can also clarify an individual's wishes regarding the donation of organs or the receipt of donated organs.
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Durable Power of Attorney
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A durable power of attorney, the second basic type of advance directive, designates a health care proxy for the individual, a person specified in the document to make all medical decisions regarding the individual's end-of-life treatment if he becomes incapacitated. These documents have the advantage of appointing someone capable of reacting to changing circumstances and addressing situations that may have not been foreseen by the more hypothetical desires established in the living will.
Third-Generation Advance Care Directives
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In addition to more standard living will and durable power of attorney documents, several "third-generation" documents have emerged to address the perceived deficiencies in the two previous types.
The most well-known of these is perhaps the Five Wishes Directive, which received a great deal of public attention after being endorsed by Mother Theresa. The directive allows users to express their general wishes or opinions on end-of-life care and can be more useful than living wills that seek to anticipate specific hypothetical situations or durable power of attorney documents, which appoint a medical proxy but do not always provide much guidance regarding an individual's personal wishes.
Legal Questions in the United States
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Most U.S. states recognize living wills and durable power of attorney designations. Due to the inability of even these very specific documents to anticipate all end-of-life care decisions, however, family members still often find themselves in the position of making end-of-life decisions for loved ones.
The Five Wishes Directive is accepted as a legal document in 42 states.
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