What are the advantages of making a Living Will?

This document allows you to state the type and extent of medical treatments and care you would or would not want to receive, in the future, should you be unable to express your wishes at that time. Possible situations could be if you developed a severe dementia (when there is no likelihood of any significant improvement) or if you suffered a very extensive stroke (with every expectation of major permanent disabilities).

Completing a Living Will form can give you reassurances about your future medical care. It will allow you much more control over your future treatment.

When healthcare professionals are faced with difficult decisions about what treatment or care to give you, if they are unable to communicate with you, this document will provide the best possible guide, and will help to ensure that your wishes are respected.

When you are thinking of completing a Living Will form, this process can also stimulate conversations on this subject of your future medical care with your family and close friends - thus relieving them of the possible burden of decision-making at what could be a very distressing time in the future.

Also, it can be very useful in a Living Will to state how your personal beliefs affect how you want to be treated. If certain religious or cultural practices need to be observed, these should be described. If it is practical, let it be known if you would prefer to die at home. There is also an opportunity to make specific requests you might have about your funeral.

Do I have to make a Living Will?

No - the choice is entirely up to you.

How does a Living Will work?

Doctors and other healthcare professionals cannot normally give you treatment without your permission or consent. And, if you are incapable of consenting or making decisions (if, in legal terms, you “lack the capacity”), they can treat you according to how they see your “best interests”.

But, in these situations, when you have become extremely ill and you are expected to remain seriously incapacitated for some time, and you are unable to tell someone how you want to be treated, the wishes you have expressed in your Living Will will have to be very carefully considered.

In 2003, the World Medical Association, at its General Assembly in Helsinki, stated that “A patient’s duly executed advance directive should be honoured unless there are reasonable grounds to suppose that it is not valid because it no longer represents the wishes of the patient or that the patient’s understanding was incomplete at the time the directive was prepared. If the advance directive is contrary to the physician’s convictions, provisions should be made to transfer the care of the patient to another consenting physician”.

It is important to stress that your Living Will only comes into effect if and when you lose the capacity to make decisions about your treatment, and you are expected to remain in this state for some time. Until
that time, you can make the decisions yourself without any reference to any written statement made in advance.

What are the limitations of a Living Will?

This document reflects your wishes at the time that it is written. Because circumstances, such as your general health or improvements in medical care, can change, it is essential to review what you have written in a Living Will at regular intervals.

Living Wills cannot compel a doctor to give you a particular type of treatment (this is a clinical decision to be made by that doctor, and may also be influenced by other factors such as financial considerations if a requested treatment is very expensive).

Living Wills should not be ignored unless they do not apply to the particular situation which has arisen, or if they are not clear regarding the treatment you want to refuse.

These documents cannot be used to refuse basic nursing care (such as simple hygiene), to stop nursing staff offering you food and drink by mouth, or to request euthanasia or unreasonable treatment.

How do I make a Living Will?

You must naturally be careful how you complete the Living Will form. It is advisable to discuss in advance, with those who are close to you, what you would want to happen to you in the event that you cannot communicate with them or with any healthcare professionals.

What you decide must be clearly stated. It is unnecessary to use medical terms, but it must be obvious what kind of treatment you are refusing or consenting to have, and in what circumstances. It is sensible to state the reasons why you have come to the conclusions you have, so that it is clear you have the necessary degree of competence to decide what treatment you want to have or what you wish not to have, and that you have not based your decisions on wrong information.

Because this document concerns your health, it is recommended that you discuss it with your GP before you sign it. Your GP can advise you on possible problems that could perhaps arise from an unclear statement, as well as explaining the advantages and disadvantages of choosing or refusing specific medical procedures in advance.

Finally, it is important to review your Living Will from time to time to be certain that it still reflects your wishes.

Who benefits from me making a Living Will?

First of all, you benefit. In the absence of a Living Will, if you are unable to communicate with them, doctors can only act in what they think are your “best interests”. Often, as strangers, they usually know nothing of your values and preferences. A Living Will should make sure that your wishes are respected.

Next, doctors benefit, as they will no longer have to guess at what you would have wanted, especially if they get conflicting views from your relatives. They will be freed from the fear of an action for negligence by your family if they abide by your requests as stated in your Living Will.

Finally, your family and friends benefit because they have documentary evidence of your wishes and are freed from the heavy responsibility of trying to make decisions on your behalf in the future, at what might be a very difficult time for everybody.

Can I change my mind?

Provided you are mentally competent at the time, you can change or cancel your Living Will whenever you like.

If you do decide to change your mind, and you write a new Living Will, then it is essential that you destroy all the past copies of the former Living Will, and ensure that the new document is brought to the attention of everyone concerned.

How long is my Living Will valid for, and do I have to renew it?

The document is valid from the date you sign it (when it has also been witnessed by two other adults).

It is advisable to review it on a regular basis. And, at least once every two years, after such a review, you should sign and date it, indicating that no changes are required. Obviously, the more recent the signature, the more certain healthcare professionals will be that what you have stated in your Living Will is still what you want.

Amendments, indicating only minor changes regarding your wishes, to the document can be made - these must be signed and dated.

However, if any major alteration is to be made, due to an important change in your health or new circumstances arising, it is definitely advisable to complete a new Living Will form (and then advising everyone who has a copy of the former document that you have done so, and giving each of them a copy of the new Living Will).

Does my GP have to sign my Living Will?

No. However, it is recommended that your GP does so.

If you discuss your Living Will with your GP, and your GP signs the document, then he or she will understand your wishes: also, if it should become necessary at some future date, this doctor can confirm that you had full understanding of what you were doing when you completed your Living Will (ie. that you had sufficient “mental capacity”).

What is a Health Care Proxy?

You should use your Living Will to nominate your Health Care Proxy.

This is an adult relative or friend who you know very well, and who you can trust to communicate your wishes to the doctor responsible for your care on your behalf, when you are no longer capable of expressing them yourself. This individual cannot make decisions for you, and this person cannot override what you have written in your Living Will - he or she can only do their best to explain your wishes and expectations if these are unclear in your Living Will.

Do I have to discuss what I am doing with my solicitor?

No. A Living Will is separate from other documents such as your regular will.

You do not need to consult a solicitor to complete a Living Will form. However, it can be advisable for your solicitor to be one of the two witnesses to your signature of your Living Will.

And, it is sensible for your solicitor to have a copy of your Living Will for safekeeping.

What are my doctor’s responsibilities regarding my Living Will?

Doctors have legal and ethical obligations to always act in the “best interests” of their patients, which includes acting in accordance with the past and present wishes of the patient. Of course, doctors must be satisfied that illness, medications or pressure from others do not affect a patient’s judgement in making decisions.

Doctors should respect what you have written in your Living Will unless there is evidence to suggest that you did not understand the implications of what you requested in this document when you signed it, or if circumstances have definitely changed.

Healthcare professionals may be legally liable for disregarding what you have requested in your Living Will if they are aware of the existence of this document, and if it is applicable to the circumstances.

If a doctor has a conscientious objection to what you are requesting in your Living Will, this doctor should step aside to allow a colleague to manage your care in accordance with the wishes you have expressed in the document.

Can I request euthanasia in my Living Will?

No. Euthanasia is illegal in Ireland.

By means of a Living Will, you are simply exercising the basic human right to choose what happens to your body. However, you cannot ask a doctor to do anything illegal.

Who should have copies of my Living Will?

As well as keeping a copy for yourself, it is important for your Health Care Proxy and your spouse or best friend to have copies. Also, it is advisable that your GP has a copy (if not, then there must be a note on your medical records that you have completed a Living Will), and perhaps your solicitor.

Of course, if you make a new Living Will, all the old copies must be destroyed, and then new copies must be given to all those who previously had one.

Should you go into hospital (or enter a rest home or nursing home), a copy of your Living Will should be shown to the doctor upon admission so that a note can be made in your hospital notes.

And, a reminder - If you have made a Living Will, you should always carry a small card (in a wallet or handbag) to indicate where a copy of your Living Will is to be found (this is very important if you have a serious medical condition, which could also be mentioned on this card).

If I am very seriously injured in a car accident and unconscious, what would happen?

If you have a Living Will, and if you remain unconscious, no decision about your long-term medical care, as expressed in your Living Will, would usually be taken until you had been carefully observed and treated for some time, perhaps for many weeks and even months.

Is my Living Will enforceable?

The Living Will form, available from this website, can be used throughout Ireland.

However, at present, the official situation regarding this document is somewhat different between Northern Ireland and the Republic of Ireland.

In 2005, the British parliament, in London, adopted the Mental Capacity Act which gave legal support to Living Wills in England and Wales, but not in Northern Ireland. However, in Northern Ireland, the concept of Living Wills has been backed by organizations such as the British Medical Association, the General Medical Council, the Law Society in London, and the Royal College of Nursing since the mid-1990s.

In the Republic of Ireland, the Medical Council, in Dublin, in early 2008, adopted a statement on Living Wills which noted that “The Medical Council recognises the right of every competent adult patient to consent to or refuse medical treatment. The objective of applying this principle to advance directives is to ensure that doctors continue to provide medical treatment to patients in accordance with their wishes and values. Where a competent adult patient makes a specific and informed decision to refuse future medical treatment in the event of his/her incapacity, this decision must be respected…..Patients should be encouraged to nominate a trusted person to interpret their wishes in the event of any ambiguity”.

While not yet legally-binding in the Republic, healthcare professionals should take into account what you have written in your Living Will when deciding on a proper course of action if you are unable to express your wishes to them. Likewise, family and friends can regard Living Wills as evidence of your wishes.

Also, it can be definitely expected that “common law” (ie. law derived from judicial precedent rather than by a parliamentary statute) will give increasing support for Living Wills throughout Ireland: this situation is already true for Northern Ireland because of decisions which have been made in the British courts in recent years.

This Living Will allows you to state your choices regarding medical treatment and care should you, at some future date, be unable to express your wishes at that time. It is important to stress that you can choose either to request all appropriate medical treatment to keep you alive for as long as reasonably possible or you can refuse such treatment aimed at artificially sustaining your life.

How will people know that I have a Living Will?

If you have completed a Living Will form, you should always carry a small card, in a wallet or handbag, which indicates where a copy of this document can be found.
One side of this card can simply say “My Living Will can be obtained from (name) at (address) (telephone number)”: the other side can note any relevant medical information about yourself, such as “I am a diabetic”, or “I have high blood pressure and am taking (name of your medication)”.