I've heard it said that the Health Care Proxy is the keys to the car, and the Living Will is the map. If you want your health care agent to be able to make good decisions for you when you are unable to decide for yourself, then you need to give them a detailed map and be specific about your wishes. A recent article in the New York Times (you need to register to read it, but registration is free) outlines the reasons for this, and gives examples of ways that lack of specificity could backfire:
Dr. Ferdinando L. Mirarchi, chairman of emergency medicine at Hamot Medical Center in Erie, Pa., tells of a very active 64-year-old woman who nearly died because a nurse read her living will as a D.N.R. statement. The woman had slipped on ice and broken a leg, which was reset surgically. On the second postoperative day she began bleeding in her abdomen, and excreted and vomited blood. But the nurse saw her living will and told the physician on call that she was D.N.R. and thus did not warrant admission to the intensive care unit. Fortunately, another physician overrode the nurse’s interpretation and resuscitated the woman, who successfully underwent emergency surgery to stop the bleeding.
You should consider whether you want life saving treatment in the case of certain diseases but not in others:
Medical consultants writing in Patient Care (Nov. 15, 2000) noted that “the less inclusive a living will is, the more trouble it can cause.” Doctors may be uncomfortable following vague directives. The consultants suggested that living wills could be more useful if the directives were disease specific. For example, if you have emphysema, you may want to accept antibiotics and mechanical ventilation if you develop pneumonia, but you may not want such treatment if you are near death from cancer.
A good Living Will/Health Care Proxy combination is the Five Wishes which asks you to really explore what decisions you want made for you, and how you want to be treated at the end of your life. This is the document I provide to my clients who need Living Wills.
Living Wills are not legally binding in Massachusetts, but you should still execute one because it will provide guidance to your health care agent and medical providers, and you could find yourself injured in a state where Living Wills are legally binding.