Making decisions about end of life care and treatment are among the most difficult that any of us have to make. These are very personal decisions and in many cases spouses will choose different end of life care plans.

According to the American Bar Association, twenty years ago half of Americans died in institutions like hospitals or nursing homes; today, it's four out of five. The medical personnel in these institutions will look to you for instruction on whether to revive you or resuscitate you. If such procedures would only mean great pain for you and prolonged anguish for your family, or would leave you in a vegetative state, you might not want them performed. But you might not be in condition to refuse them. Or you may be in a situation where you want to live, but can't manage your affairs.

In cases that have made headlines over the past few decades (Terri Schiavo among the most recent) courts have ruled that all mentally competent adults have the right to refuse medical care. If you're in a condition in which you can't communicate, and there is clear evidence of your wishes regarding treatment (such as a living will), those intentions must be obeyed.  What you're trying to avoid is the agonizing situation of your partner or children gathered around your hospital bed, asking each other and your doctor, "What would she want us to do?"--and you being unable to tell them.

If you provide your family with a living will (also known as an advance medical directive [AMD] or advance healthcare directive), you give them guidance of what medical care and/or procedures you do or do not want should you become incapacitated due to injury or illness. It often covers such items as removing life support if your incapacity results in a persistent vegetative state or specifies “do not resuscitate” (DNR) instructions. The living will is effective only if you are unable to consciously make your own end of life decisions when needed. In other words, your family cannot make this type of decision for you so long as you are legally competent to do so on your own.

If you should become incompetent, however, having a living will in effect will make things easier for your family members if they need to make decisions on your behalf. The living will provides your loved ones with your wishes on end of life care. This will no doubt give them some peace of mind at a very difficult time.

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