An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity.
In some countries it has a legal status in itself, whereas in some others it is legally persuasive without being a legal document.
A living will is one form of advance directive, leaving instructions for treatment. Another form is a specific type of power of attorney or health care proxy, in which the person authorizes someone (an agent) to make decisions on their behalf when they are incapacitated.
People are often encouraged to complete both documents to provide comprehensive guidance regarding their care.
Patients can give their preferences for their end-of-life care by making a living will. A patient records in writing his or her wishes for future care, addressing end-of-life scenarios in a standardized fashion.
Limitations: one may not be able to foresee the actual circumstances of one’s terminal condition; the will may be too vague about the unique conditions surrounding one’ death; it may be too generic to extend a patient’s autonomy beyond the point of incapacity; written wishes may be ambiguous – if the there is a request for no intubation, it is difficult to determine whether it is a rejection of mechanical ventilation or a desire to avoid prolonged ventilator assistance when there is no scope for recovery in which case the patient may accept a trial of ventilation for a potentially reversible condition.
Fins JJ, Nilson EG. Withholding and Withdrawing Life-sustaining Care. Hanks G, Cherny NI, Christakis NA, Fallon M, Kaasa S, Portenoy RK (Ed).Oxford Textbook of Palliative Medicine. Oxford University Press, Fourth Edition, 2010, pp-320-329.