Living Will

Advance Directive
An advance Directive is a legal document which will allow medical doctors not to keep you alive under circumstances where the result of non-treatment is early death. It is a brief document. Without this document they are obliged to preserve your life at all costs and could expose themselves to legal action if they fail to treat you. We recommend that where your country has legal provision for an Advance Directive, you should make full use of that facility.

Living Will
In a Living Will you can express, in your own words, your rational choice of when to discontinue life support and when to withhold treatment of a fatal illness if you are already suffering from a condition from which there is no hope of recovery. It is not a legal document in the same sense as an Advance Directive and so you can express yourself in whatever terms you wish, generally a Living Will is a much more expansive document than the prescribed form of Advance Directive. Doctors will be much better able to see what you would really want if you do a Living Will. Without it decisions are made without any real input from you, the patient, and they will have to rely on information given to them by your proxies, and of course your Advance Directive. I have given an example of the English version at the bottom of this article so you can see for yourself what it is like.

We recommend that you have an Advance Directive and a Living Will.

It should be noted that an Advance Directive made according to the laws of one country will not necessarily be accepted by anywhere else because of the ‘prescribed form’ requirement. The same applies to Powers of Attorney (Enduring or otherwise). You might actually need two or more if you live and work overseas.

If you have terminal cancer in its advance stages and you catch pneumonia, or have a heart attack or stroke, do you want to be revived under such circumstances? Doctors may be reluctant to accept the decisions of a seriously ill patient because of uncertainty about his/her rational state of mind, or he or she might simply be unconscious or not able to speak. By drawing up an advance directive your health care providers may have some legal protection, and so lessen the chances of a lawsuit against them. They are then more likely to carry out your wishes for life support and treatment. A Living Will gives them a clear picture of your wishes in addition to the legal weight of an Advance Directive.

Pre-determining the precise circumstances in which treatment should be withheld is very important, so is stating which members of your family and friends should have the power to decide at what point to withdraw life support or other treatment.

A Living Will does not carry the same legal status as that given to a Last Will and Testament in England or Hong Kong. However, it is generally accepted as a helpful addition to an Advance Directive, which may be a short, formal document prescribed by law. England and Wales now accepts a correctly drawn up Advance Directive, but they are pretty basic.  A Living Will is your opportunity to expand on the basic provisions of Advance Directives. It must be made at a time when you are in full possession of your mental faculties and may be revoked or altered at any time prior to mental incapacity. It is advisable to review (and revise if necessary) it from time to time, as you would your Will, just to make sure that what it says is still what you want to happen. We suggest every two years.

The British Medical Association strongly supports the principle of Living Wills, and recognises the appointment of health care proxies in an Advance Directive (a proxy is a person appointed by you to act on your behalf and in accordance with your instructions.)

Doctors are not obliged by their professional ethics to comply with a Living Will, but must be prepared to allow other doctors to take over the treatment of a patient who has expressed a wish, in writing, about his or her treatment. It is strongly recommended that a Living Will should be drawn up with the knowledge and co-operation of your General Practitioner and any other doctors who are concerned with your treatment. Once signed, a copy of the Living Will must be lodged with your GP. Doctors who have conscientious objections to the principle of a Living Will should advise their patients of their views at the outset. Living Wills cannot be used to insist upon specific treatments (for example, euthanasia).

At time of writing, the Hong Kong Government has issued a consultative document on Living Wills, but no formal policy has yet been agreed. More information on this topic can be found at www.hkreform.gov.hk/reports/index.htm.

England and Wales have just introduced the Lasting Power of Attorney, which incorporates an Advance Directive.

Each state in the US has its own version!

Australia and New Zealand both have legally accepted Advance Directives which must be on a prescribed form (that is, the format and wording must be as stated by the relevant law of the country/state and not your own version!) Of course Australia varies the rules in each state, so do look up your state Government web-site to see the latest version.

There are lots of changes happening in this field. The US led the way years ago with the concept and country after country has since made headway with its own version. There are different interpretations of Advance Directives; liberal countries such as the Netherlands will permit far more than conservative England. Yet changes are happening all the time so do make sure you have up-to-date information from your own government department responsible. Each country in continental Europe has its own version and so do some Asian Countries. This is very much in a state of change and probably will be for some time, so for the latest information go to the government web-site for your country and use the keyword Advance Directive to search the site.