Advance health care directive

A living will, also called will to live, is one type of advance health directive, or advance health care directive. It is often accompanied by a specific type of power of attorney or health care proxy. These are legal instruments that are usually witnessed or notarized.


 * A living will usually covers specific directives as to the course of treatment that is to be taken by caregivers, or, in particular, in some cases forbidding treatment and sometimes also food and water, should the principal be unable to give informed consent ("individual health care instruction") due to incapacity.


 * A power of attorney for health care appoints an individual (a proxy) to direct health care decisions should the principal be unable to do so.

As the name suggests, the term "will to live", as opposed to the other terms, tends to emphasize the wish to live as long as possible rather than refusing treatment in the case of serious conditions.

In the Netherlands, patients and potential patients can specify the circumstances under which they would want euthanasia for themselves. They do this by providing a written euthanasia directive. This helps establish the previously expressed wish of the patient even if the patient is no longer able to communicate. However, it is only one of the factors that is taken into account.

In Switzerland, there are several organizations which take care of registering patient decrees, forms which are signed by the patients declaring that in case of permanent loss of judgment (e.g., inability to communicate or severe brain damage) all means of prolonging life shall be stopped. Family members and these organizations also keep proxies which entitle its holder to enforce such patient decrees. Establishing such decrees is relatively uncomplicated.

In the United States, most states recognize living wills or the designation of a health care proxy. However, a "report card" issued by the Robert Wood Johnson Foundation in 2002 concluded that only seven states deserved an "A" for meeting the standards of the model Uniform Rights of the Terminally Ill Act. Surveys show that one-third of Americans say they've had to make decisions about end-of-life care for a loved one.

The Terri Schiavo case
During the early part of 2005, the case of Terri Schiavo generated much interest in living wills. The Robert Wood Johnson Foundation study concluded that only 15 percent to 20 percent of the U.S. population had living wills in 2002. By contrast, public opinion surveys taken during the Schiavo controversy showed that about 37 percent of Americans said they had a living will, but 69 percent of those without a living will said the case made them think about getting one.

A number of entities have reported an upswing in requests for forms or other information on living wills. The non-profit organization Aging with Dignity has said that they have received thousands of calls and e-mails concerning living wills. The Westfield, New Jersey-based U.S. Living Will Directory national registry reported the number of hits on their website went from about 500 to 600 per day to well over 5,000. Others, such as lawyers, hospitals, and state bar associations, have also seen an increased interest in living wills.

Many have highlighted Schiavo's case to make the point that people should make living wills regardless of age or current health status, pointing to the fact that even younger people can face terminal illness or have an accident. For example, Schiavo suffered her brain injury when she was only in her mid-20s. They also feel that expressing one's wishes verbally is not enough, and that those wishes should be formally documented. Legal experts say that the entire court battle could have been avoided if Schiavo had properly documented her wishes prior to her collapse. However many other experts have found that the strength of living wills has been overstated: