What’s the difference between a living will and an advance directive?
You may already be considering the pros and cons of an advance directive vs. a living will. After all, advance directives and living wills are often confused, and understandably so. But it's worth noting that there are some very important differences between living wills and advance directives. First, an advance directive is a broad category of legal instructions that outline your health care wishes. There are many types of documents that fall under the category of advance directives. One of them is a living will, which is created specifically to express your preferences for medical treatment if you become terminally ill.1
What is a living will?
Let's begin with the living will, which is a type of advance directive. This written document outlines your health care wishes for end-of-life care if you become terminally ill and cannot make these decisions on your own. It tells your medical providers the medical treatments you may or may not want if you’re permanently unconscious or at the end of a terminal illness, including how long you want your life prolonged. It might also include your religious preferences.2
What is an advance directive?
An advance directive is a set of instructions that outlines your health care wishes. It, too, is used when severe medical situations occur and you're not able to communicate your wishes. Unlike the living will, however, an advance directive isn’t limited to terminal illness. It may also include medical events such as dementia, stroke or coma.
There are many different types of advance directives, including, but not limited to, a living will, medical power of attorney and do-not-resuscitate (DNR) order.3
Medical orders are created by medical professionals in consultation with their patients, in order to inform other medical professionals about your wishes regarding different life sustaining treatments. Most of these orders are created when a patient is terminally ill.
A do-not-resuscitate (DNR) order instructs the medical staff not to enact life-saving measures such as cardiopulmonary resuscitation or an automated external defibrillator. A do-not-intubate (DNI) order instructs the medical staff that you do not wish to be intubated.3
A Portable Order for Life Sustaining Treatment (POLST) instructs emergency medical personnel regarding cardiopulmonary resuscitation (CPR) and the extent to which they should apply other medical interventions (e.g., comfort measures only, limited treatment or full treatment). POLST documents may go by various names, such as Medical Orders for Life-Sustaining Treatment (MOLST) or Transportable Physician Orders for Patient Preferences (TPOPP).
Medical power of attorney
A medical or health care power of attorney (POA), sometimes called a durable power of attorney for health care or simply a medical POA, is a legal document that allows you to name someone as your health care proxy or agent. This person can make your health care decisions if you're unable to do so. In order for the health care agent to act, the patient's physician must first certify that the patient is not able to make medical decisions.
Power of attorney appointments are not typically made in living wills; thus, many people need both documents.
If you want to be absolutely certain that your wishes are carried out, an advance directive² may be your best choice. A medical power of attorney empowers your health care agent to speak with your physicians and enforce your health care wishes. A living will express your preferences for end of life care so that all medical personnel and family members know your preferences and further empowers your health care agent to act in accordance with what you desired, notwithstanding any personal objections from friends or other family members.
State-specific estate laws
As if this isn't already complicated enough, you should be aware that state laws regarding these documents vary. That's why it's important to familiarize yourself with the laws in your state. And if you spend a significant amount of time in more than one state, talk to your health care provider and estate planning attorney about the best course of action.
Advance directives are state-specific
Every state allows for certain types of advance directives, so check the laws in your state to make sure you know what's available. For instance, some states allow verbal advance directives while others do not. Still, there is no set template for what must be included in a living will or an advance directive, so the written documents can vary significantly.
Be sure to weigh the pros and cons of the various advance directives and how they might be used to best enact your medical treatment wishes.
Completing a living will and durable power of attorney for health care is a great way to jump-start your overall estate plan. Consult with a financial professional to learn more about other important estate planning tools and techniques, as well as the most efficient ways to transfer your assets to heirs This handy estate planning checklist will help you get started.