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The Loving Will: An Ethical Alternative to 'Living Will' Documents
Wednesday, October 12, 2005 - By ALL

What is the LOVING WILL?

The LOVING WILL is a document that tells your doctor and other health care personnel how to take care of you should you become so sick that you are unable to communicate your wishes. In short, it instructs health care personnel to do nothing intentionally, by act or omission, to cause your death.

To request the LOVING WILL package, please contact the American Life League Resource Department or call toll-free 866-538-5483. Please provide a name and address, as the Loving Will cannot be sent by e-mail. There is no charge for the documents, but we do ask for a shipping and handling fee of $9.95 for each package.

Does the LOVING WILL have anything to do with my will in which I decide who will receive my property after I die?

No. The LOVING WILL deals only with your medical treatment and care should you become unconscious or otherwise unable to communicate because of illness or injury. It has no bearing on the distribution of your estate.

Why would I need a LOVING WILL?

Two reasons-

  • the practice of withholding treatment and care (even food and water) is becoming more and more common in medicine today, and
  • a 1991 federal law increases the chances that you may feel pressured to sign something like a "living will" that will not protect your life.

You say that it's becoming more common to withhold medical treatment, and food and water from patients today. That's because more people request that they do not receive medical treatment, and food and water, right?

Not always. The term "medical treatment" today is often interpreted to include giving someone food and water through a tube. Sometimes the wording of a "living will" is so vague that a patient may not realize that, by signing it, he or she may be requesting starvation and dehydration in certain circumstances. In fact, sometimes a "living will" is so unclear that even doctors and nurses are unable to determine whether a patient wants to be given food and water when the patient is unable to communicate.

What's more, according to recent reports, some medical personnel assume that by signing a "living will," the patient automatically indicates he or she does not want to be given even minimal care in certain circumstances.

But what if I don't have a "living will" - if I haven't signed any documents that could cause me harm, why do I need to bother with a LOVING WILL?

You may need a LOVING WILL to help protect yourself. A general inclination appears to be emerging in the medical community to withhold medical care and treatment that does not improve the patient's "quality of life"-unless there's evidence that the patient wants such care and treatment. Your LOVING WILL would be the positive evidence doctors might need just to provide you with even basic food and water.

Before I ask about "living wills," you said that the second reason I need a "LOVING WILL" involves a 1991 federal law. What's that?

It's the Patient Self-Determination Act, a bill that was passed by Congress and went into effect on December 1, 1991. It says that facilities receiving federal Medicaid or Medicare funds (and that means nearly all hospitals) must give adult patients, at the time of admission, written information on the "advance directives" that are legally available.

What is an "advance directive"?

It's a document intended to instruct medical personnel on the kind of health care you would like to receive should you become unable to communicate your wishes. Common examples are a "living will" or a type of document called a "durable power of attorney for health care." This latter document gives the power to make decisions about your health care to another person of your choosing. Every state now has laws authorizing one or more forms of advance directives.

So, why does the Patient Self-Determination Act (PSDA) increase my need for a LOVING WILL?

The PSDA requires that whenever any adult is admitted to a hospital for any reason, he or she must be informed about "living wills" or other types of "advance directives" available by law. In practice, this federal requirement can make people think that they must have an "advance directive." They may then feel pressured to sign a "living will" or "durable power of attorney for health care" that could have the effect of stopping their medical care and treatment-even medical care and treatment that could save their lives!

That brings me back to the "living will." Why is it so bad?

The popular perception about the "living will"- that it allows a person to refuse unwanted medical treatment that unnecessarily prolongs impending death-seems harmless. The problem is that the "living will," as it is now interpreted in most states, allows not just the refusal or withdrawal of truly "extraordinary" medical treatment, but food, and water, and any medical treatment, whether or not death is near.

How is this possible?

"Living wills" are usually written to take effect when you become unable to express your informed consent for "medical treatment." Typically, they instruct medical personnel to withhold or withdraw "medical treatment" if you are in a "terminal" condition. State laws and court decisions are not only defining "medical treatment" to include the provision of food and water, but are also defining "terminal" to include many patients who are neither dying nor near death.

For instance, if you could not respond to visual, auditory and tactile stimuli for a prolonged period and if you were being given food and water through a feeding tube, the chance exists that your doctor would remove your feeding tube because your "living will" said that you didn't want "medical treatment."

You mean that a doctor could cause death or kill a person by starvation or dehydration?

Yes. A growing number of medical personnel and "ethicists" assume that making some people die by starvation or dehydration is preferable to letting them live with an illness or injury.

Can't it be said, though, that if a person is really sick or injured, stopping his or her food and water lets that person die a "natural" death?

No. Denying food and water to a sick or injured person no more "allows" a person to die a "natural death" than starving a healthy person locked in a room. Making someone die of dehydration or starvation is not a "natural" death.

Besides food and water, what other types of beneficial care or treatment might be withheld if a person has a "living will"?

For instance, it's possible that antibiotics might not be administered to treat an infection of an Alzheimer's patient, or that insulin might not be given to a comatose diabetic.

So, would a LOVING WILL help protect me from being starved or dehydrated?

Yes. It specifically states that nothing is to be omitted or done to you "with the intent to cause [your] death." What's more, it declares that you are "not to be denied food or water as long as [your] body is able to assimilate them."

How will medical personnel know this if I can't communicate?

To ensure that you receive the necessary medical treatment a copy of the LOVING WILL should be given to your physician(s) and made part of your medical records in and out of the hospital, and you should discuss it with your physician(s) and anyone else to whom you are close. The best way, however, to make sure that your wishes are made known is to also authorize someone to speak for you in the event that you cannot. The LOVING WILL specifically allows you to appoint an "attorney-in-fact" who would be given a limited "Durable Power of Attorney" to make health care decisions for you should you become unable to communicate your informed consent because of illness or injury.

Why shouldn't I just sign a regular "durable power of attorney for health care" without a LOVING WILL? Wouldn't that make it easier for the person whom I appoint to make medical decisions for me?

No, not if you've also signed a LOVING WILL. The LOVING WILL declares that your decision maker, your "attorney-in-fact," cannot order food or water withheld or withdrawn from you as long as your body can assimilate them, nor can this person act inconsistently in any other way, with your LOVING WILL.

Aside from this guarantee about food and water, what else does the LOVING WILL do for me?

It instructs the people who treat you to provide "medical treatment and care if necessary to cure, remedy, or relieve the symptoms" of your condition. It also directs these persons to use a "maximum effort" to relieve any pain you may have and to keep you clean and comfortable. If you are pregnant, it asks that maximum effort be made to save your life and the life of your child. It forbids anyone from making the "quality" of your life a factor when considering your treatment or care.

What if there are certain medical treatments that I do or do not want? How does the LOVING WILL help me with these?

It is important to understand that the LOVING WILL provides only basic guidelines for your care and treatment. It does not specificy treatment in-structions because it is simply impossible to foresee everything that could happen to you, along with the available treatment options and how you would want to proceed in each case. Moreover, the moral obligation to be conscientious stewards of our lives requires that these types of decisions be made on the basis of facts and circumstances existing at the time of treatment.

Our moral obligation is to use "ordinary" means of medical treatment and care to preserve our lives, while "extraordinary" means are optional. Why doesn't the LOVING WILL say this?

The LOVING WILL is intended to require that you be given, at a minimum, "ordinary" means of medical treatment and care (food and water, necessary treatment, pain relief and comfort care, as noted above). The LOVING WILL does not use terms like "ordinary" and "extraordinary" because these words are, now more than ever, subject to interpretation that distorts their proper, traditional meanings. For example, the provision of food and water was once commonly considered "ordinary" and is now increasingly considered "extraordinary." The authors of the LOVING WILL determined that it was simply not possible to define these terms carefully enough to avoid this problem while maintaining a simple, one-page, easy-to-use fomat.

But what if I do or don't want to receive "extraordinary" treatment?

It is true that the LOVING WILL does not address specific considerations, such as cost or other hardship, that might determine whether a certain medical treatment is truly "extraordinary," that is, gravely burdensome for you to bear or otherwise requiring heroic virtue on your part. However, you can discuss this wish with your physician(s) and your appointed decision maker (attorney-in-fact) under the Durable Power of Attorney in the LOVING WILL. Make sure that they understand the proper moral principles on which to make a decision for you regarding "extraordinary" means when the need arises under the facts and circumstances of your case. American Life League's publication, Life, Life Support, and Death, included with the LOVING WILL package, defines and describes these principles.

What if there is conflict over how my LOVING WILL is to be interpreted?

The LOVING WILL specifically states that it "is to be interpreted in favor of continued life." In other words, any ambiguity is to be resolved in favor of continuing your life.

Couldn't it be said, then, that by signing the LOVING WILL, I would be asking that all possible means of medical technology be used to keep me alive, even on my deathbed?

Nothing in the LOVING WILL requires this, and it is doubtful that the LOVING WILL would be interpreted this way. Given the emerging "quality of life" ethic and growing trend among medical professionals not to treat certain patients, the LOVING WILL is based on the presumption that, in the future, medical personnel will be far more likely to misinterpret a document in favor of under-treatment or even non-treatment rather than in favor of over-treatment.

Is the LOVING WILL a legal document like the "living will"?

The LOVING WILL and its accompanying Durable Power of Attorney were created in response to state laws authorizing "living wills" and the like, which can jeopardize a person's life and health as explained earlier. Since the LOVING WILL package may not be specifically envisioned by these laws and in important ways is antithetical to them, it may not be legally recognized and directly enforceable in a court in every state. Properly executed and circulated, it should make your wishes sufficiently clear to alert health care providers of a possible risk of malpractice actions should they act against your wishes.

It is important to emphasize that this paper and the LOVING WILL package are not legal advice, and it is always advisable to consult with your attorney in such important matters.

The LOVING WILL helps protect me if I become sick or hurt and cannot communicate with the doctor. It would tell my doctor or a nurse that I want to receive water and food, be kept clean and comfortable, treat my illness or injury, and keep me as pain-free as possible. Is that correct?

Yes. The LOVING WILL is an attempt to safeguard against euthanasia being practiced on you. It establishes a minimum amount of care and treatment that you want medical personnel to provide. In short, it gives notice that you do not want to be made to die.

 


To request the LOVING WILL package: Please contact the American Life League Resource Department or call toll-free 866-538-5483. Please provide a name and address, as the Loving Will cannot be sent by e-mail. There is no charge for the documents, but we do ask for a shipping and handling fee of $9.95 for each package.

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Janine Enger | 2014-05-05 11:02:41
Is this Loving Will the same, or similar to, the one called "PMDD: PROTECTIVE MEDICAL DECISIONS DOCUMENT" ?
Michael Boerste | 2014-03-11 15:58:39
Does the form have a witness/notary section? Is such a second signature required to make the completed document official?
Celine Souza | 2014-02-16 18:51:38
My 83-year old dad wants a "Do Not Resuscitate" form on our fridge for emergency personnel in case he has an emergency while we're gone (periodically). I want him treated if he breaks something in a fall, and so does he. However, if it's a heart attack or something akin to that, he does not wish resuscitation. Does the Loving Will handle a situation such as a "DNR"? Or have forms for emergency personnel?
Jim Sedlak | 2014-02-17 14:27:32
Celine. The short answer is NO. A general Do Not Resuscitate order, filled out in advance, would be counter to the purpose of a Loving Will. The essence of the Loving Will is that the signer recognizes that life is a gift from God and that the signer will die when God chooses. Until that death, the Loving Will instructs care givers to provide all normal and reasonable care – which includes providing nutrition, hydration, a hospitable environment, and oxygen. Resuscitating a person who’s heart has stopped is normal care and would be expected to be done. As would the insertion of a ventilator or feeding tube.
Kathleen Willett | 2013-03-07 18:36:22
I need to have more than one....can I order one and copy them? Thank you.
Donna Troyanowski | 2011-12-12 16:38:37
I would like a Loving Will please.
Dwain Currier | 2011-12-13 18:58:36
In order to receive the Loving Will we need more information. Please call us at call toll-free 866-538-5483.
John Herro | 2011-02-21 12:48:02
Please send one more Loving Will package.
Tom Mon | 2011-02-24 11:12:45
Thank-you! Your request has been forwarded to the appropriate department. Your package will be sent as soon as your order has been processed.
James P. Blier | 2011-02-03 13:21:14
Is the Loving Will available as an Adobe PDF File for easy printing and filling in/editing?