Should You Have a Living Will?

February 7th, 2011 | Sources: NEJM, NY Times


A living will is a legal document that enables you to specify your preferences about end-of-life care at a time when you are clear of mind and perfectly able to do so. The document usually covers things like whether you want breathing machines and tube feedings to be used to prolong your life if you have a terminal illness, whether you want providers to attempt resuscitation in the event you are terminally ill and stop breathing, and so on.

The living will avoids confusion because your family members and caregivers will know how you feel about such situations even if you can’t express your feelings at the time they actually happen.

The Case For Living Wills: The vast majority of health care providers, especially those who frequently care for patients with terminal illness, feel quite strongly that their patients should complete a living will, no matter how uncomfortable that process may be.

Numerous scientific studies support this position. For example, in an April 2010 study in the New England Journal of Medicine, scientists found that nearly 30% of all elderly Americans did in fact encounter situations near the end of their lives when these documents would have helped assure they received the care they wanted.

Shortly before that study was published, a  separate study showed that advance care planning improved “end-of-life care and patient and family satisfaction, and reduced stress, anxiety and depression in surviving relatives.”

And before that one appeared, a third one revealed that “end-of-life discussions between doctor and patient helped ensure that one got the care one wanted,” and therefore “protected patient autonomy.”

Recent Political History of the Living Will: These and other studies support the Obama administration’s longstanding efforts to pay physicians for time spent helping Medicare patients develop living wills and other forms of advance directives.

During the epic health reform debate of 2009-2010, House Democrats attempted to include provisions authorizing such payments in the evolving legislation. However, the effort fell prey to scurrilous attacks by Sarah Palin, House Minority leader John Boehner and others. Memorably, Palin said the provisions allowed the government to create “death panels,” of all things. For his part, Boehner claimed the provisions would “start us down a treacherous path toward government-encouraged euthanasia.”

The scare tactics worked. Democrats eventually jettisoned the provisions before the final law was passed. Worse yet, a recent Kaiser Family Foundation poll revealed that a shocking 30% of elderly Americans believe the new health law empowered government panels to make end-of-life decisions for Medicare beneficiaries. To be clear, the new law contains no such provision, and living wills have absolutely nothing to do with “government-run health care” in any way.

Recently, the Obama administration made another brief attempt to pay physicians for time spent advising Medicare patients about living wills. The attempt involved invoking a new Medicare regulation that adds “voluntary advance care planning” to the packet of services covered as part of a beneficiary’s annual visit to the doctor.

Alas, the administration shelved the regulation just weeks after it went into effect  after deciding that “the opportunity for the public to comment on it was too limited.”

So, Should You Have a Living Will?: Ask your doctor. Almost certainly, he or she will say, “yes.” It’s the only way to assure you will get the kind of care you want if the time ever comes when you are severely ill, incapacitated, or otherwise unable to address the matter…that is exactly the time when your family and caregivers need to understand what you want.

It’s not necessarily an enjoyable thing to do, but consider the alternative.



  1. California Health Care Directive Attorney | 8/02/11

    In California, it is imperative that everyone create an Advanced Health Care Directive just in case they can not make decisions for themselves, should they become physically or mentally incapacitated. Otherwise an embarrassing, time-consuming, and expensive Court Conservatorship will be needed for someone to help you. To watch a video about this, click here.

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