I did not intend to create this post but because of the interest my last post made I decided to add this one.
Many have asked not only here but during the many hospital admissions that I have had to read my living will. Being on the “Inside” of healthcare I have seen the many loopholes that both family and physicians have used to get around a persons living will and provide treatments that the patient NEVER wanted.
The two biggest examples that I know of are as follows:
1. Excluding “Treatable/Reversible” conditions. Let’s say that a persons living will states no to mechanical ventilation. That person then develops a pneumonia that is causing them to go into respiratory failure. If their living will is not specific enough they may still be put on a ventilator. Why? the argument goes that the no to mechanical ventilation in the living will never meant if they had a treatable condition that can be reversed, only long term ventilation. “We will put the patient on the ventilator for a few days for their pneumonia, and allow the antibiotics to work. Then when they are better we will take them off the ventilator.” No one considers what to do if the patient does not get better or even gets worse. It is much harder to build up the moral courage to take someone off “life support” than to start it in the first place.
2. Invasive vs. Non-Invasive. Again the living will says no to ventilation, but many physicians and facilities interpret this to mean ventilation, when a breathing tube is placed down the patient throat into their trachea (windpipe) and hooked up to a machine. But unless specified, they will go ahead with non-invasive ventilation (BiPAP), where a mask is strapped onto the patients face and then hooked up to the machine that pumps in the oxygen. This type of ventilation was never designed for long term continuous use. While used as a temporary fix for the patient, again if the patient does not get better, a decision must be made to either remove this ventilator or go onto invasive ventilation. Often patients are left in ventilatory limbo as families can not decide what to do and the non-invasive ventilation goes on , continuously well beyond it’s intended purpose. This can lead to pressure from the mask that causes skin breakdown and wounds of the face that are like bedsores. I have seen where despite all the skincare in the would patient who have had breakdowns to the bone. How sad is that.
So I have tried to put in as many clauses as I can think of to help close these loopholes in my living will.
Lastly, I included a clause “wrongful life” clause in my living will the forewarns others that they will be sued if they violate my living will. Many have said that this clause my not hold up in court. If that is true, so be it, at least my point is made.
So here is my living will.
“I, ___________, do hereby state that this document is intended to be a statement regarding the medical treatment I may require in the future. At this time, I am of sound mind realize the full implications of my decisions, which are set forth below. I request that these decision be respected and that any decision I make regarding my medical treatment be respected by all physicians, nurses, and other hospital personnel.
I have decided that the quality of my life may suffer as a result of the need to amputate certain of my limbs and, therefore, I have decided that I may refuse additional amputations. I fully understand the consequences of my decision which may include, but are not limited to, allowing any infection to spread throughout my body, which may ultimately result in my death. Notwithstanding these consequences, it is my decision that I be allowed to decide for myself whether or not I will consent to additional amputations.
In addition, I have decided that the quality of my life will suffer as a result of the need for dialysis and therefore, should the time come when dialysis treatment is necessary, I do not consent to having same provided to me. My decision takes into account all of the known advances in the treatment of dialysis and notwithstanding same, it is my decision that I will not allow dialysis treatment at any time.
I also have decided that at no time will I accept a mechanical ventilation system to be used on me, whether invasive or noninvasive and whether or not such mechanical ventilation system is necessary for a “reversible” condition.
I have also decided that at no time will I allow the use of feeding tubes or strong cardiac drugs. I also request that in the event of respiratory and/or cardiac arrest, that no CPR be undertaken.
If the time comes when others decide the decisions I have made, as set forth above, are not in my best interest and they decide, notwithstanding my express decisions set forth above, to perform any treatment that I have expressly indicated herein that I do not want or that I orally indicate that I do not want, I shall consider filing a wrongful life suit against them. In such suit, I shall seek, among other things, damages for pain and suffering as well as any cost incurred by me or my family as a result of said decision, which shall include, but not be limited to, any additional health care costs. Should anyone decide to make decision regarding my health and medical treatment that are contrary to my decisions as set forth herein or as I may decide in the future, said person, and not myself or my family, shall be responsible for any and all costs that I incur as a result of said decision.
I direct that medication be liberally administered to me to alleviate pain even though it may hasten the moment of my death.
I do not intend any direct taking of my life, but only that my dying not be unreasonably prolonged.
This request is made, after careful reflection, while I am of sound mind.”
2 comments
Thank you for posting this.
Thank you for posting this — I’d altered my AD am will register it with my state soon.
Is there a lot of leeway with different doctors in different hospitals on how closely they follow your AD? I’m thinking about shooting myself in a very isolated wilderness area and one fear that I have is that if someone finds me before I die, I’ll get taken to some rural hospital where everyone has extremely conservative religious values and won’t let me die. If that’s the case, I might be better off shooting myself in downtown Los Angeles.