Few conversations are harder than talking about end-of-life care. Yet without these discussions—and proper documentation—families face agonizing decisions during already devastating times.
A living will removes the guesswork. It's your parent's voice when they can no longer speak, clearly stating what medical treatments they do and don't want at the end of life.
This guide will help you understand what a living will is, what it covers, and how to help your parent create one that reflects their true wishes.
What is a Living Will?
A living will is a written legal document that specifies which medical treatments a person wants or doesn't want if they become terminally ill, permanently unconscious, or unable to communicate their wishes.
Unlike a regular will (which addresses property after death), a living will speaks while the person is still alive but unable to make decisions. That's why it's called a "living" will.
Other names for a living will include:
- Advance directive (though this term sometimes includes healthcare proxy)
- Directive to physicians
- Medical directive
- Declaration regarding life-prolonging procedures
What a Living Will Does
- Documents specific treatment preferences in advance
- Provides guidance to doctors and healthcare agents
- Removes burden of decision-making from family members
- Ensures your parent's values guide their end-of-life care
- Reduces conflict among family members about what the person would want
What a Living Will Does NOT Do
- Does NOT name someone to make decisions (that's a healthcare proxy)
- Does NOT cover every possible medical scenario
- Does NOT take effect for routine medical decisions
- Does NOT distribute property (that's a regular will)
- Does NOT necessarily mean "do not treat"—it documents preferences either way
Living Will + Healthcare Proxy = Complete Protection
A living will documents wishes, while a healthcare proxy names a person to make decisions. Together, they form complete advance directives. The living will guides the healthcare agent, but the agent can adapt to situations the living will doesn't address.
When Does a Living Will Take Effect?
A living will doesn't activate for routine medical care or temporary illness. It only takes effect under specific circumstances.
Typical Activation Conditions
Most living wills activate when ALL of the following are true:
- Terminal condition: An incurable illness that will cause death in a relatively short time regardless of treatment
- Permanent unconsciousness: Persistent vegetative state or irreversible coma
- End-stage condition: Irreversible condition that will result in death in a relatively short time
- Unable to communicate: Cannot express their own wishes
A physician (sometimes two) must certify that these conditions exist before the living will guides treatment decisions.
What Doesn't Trigger a Living Will
- Temporary unconsciousness from surgery or anesthesia
- Treatable conditions, even if serious
- Reversible illness or injury
- Situations where recovery is possible
- Routine medical procedures
The Living Will is Not a "Give Up" Document
A common misconception is that a living will means "don't treat me." In reality, your parent can specify that they WANT aggressive treatment. The document simply ensures their preferences—whatever they are—are followed.
What Does a Living Will Cover?
A living will addresses specific medical treatments and interventions. Your parent can accept or refuse each type of treatment.
Life-Sustaining Treatments
CPR (Cardiopulmonary Resuscitation)
When the heart stops beating:
- Chest compressions
- Defibrillation (electric shocks)
- Medications to restart the heart
- Breathing assistance
Your parent can specify whether they want CPR attempted, and under what circumstances.
Mechanical Ventilation
Breathing machines that:
- Deliver oxygen through a tube in the throat (intubation)
- Breathe for the person when they cannot breathe on their own
- May be temporary or long-term
Options include: always want, never want, want for limited trial period, or want only if recovery is likely.
Artificial Nutrition and Hydration
Feeding and fluids delivered through:
- Feeding tube through the nose (NG tube)
- Feeding tube through the stomach (PEG tube)
- IV fluids
This is often the most difficult decision for families. Your parent can specify preferences for different scenarios.
Dialysis
Machine that filters blood when kidneys fail:
- Typically required multiple times per week
- Can be temporary or permanent
- Life-prolonging but demanding treatment
Antibiotics and Other Treatments
For infections that may be life-threatening:
- IV antibiotics for pneumonia or sepsis
- Treatment for infections that could cause death
- Some people want comfort-only care at end of life, declining aggressive treatment of infections
Comfort Care Preferences
Even when declining life-prolonging treatments, your parent can specify they always want:
- Pain medication: Even if it may hasten death
- Positioning and hygiene: Physical comfort measures
- Emotional support: Spiritual care, family presence
- Symptom management: Treatment for nausea, anxiety, shortness of breath
Additional Preferences
Living wills can also address:
- Organ donation: Whether organs can be donated after death
- Tissue donation: Corneas, skin, bone, etc.
- Autopsy: Whether to permit examination after death
- Location of death: Preference for home vs. hospital
How to Create a Living Will
Creating a living will doesn't require an attorney, but it does require careful thought and proper execution.
Step 1: Reflect on Values and Wishes
Help your parent think through questions like:
- What makes life worth living for them?
- What conditions would they consider unacceptable?
- How do they feel about being kept alive by machines?
- What are their religious or spiritual beliefs about end-of-life?
- What have they seen with friends or family that influenced their views?
- What's more important: length of life or quality of life?
Step 2: Learn About Treatment Options
Understanding what treatments actually involve helps make informed decisions:
- Talk to your parent's doctor about their specific health conditions
- Ask what realistic outcomes might look like
- Understand the burdens and benefits of each treatment option
- Consider watching educational videos about life support
Step 3: Choose a Form
Several options for creating a living will:
State-specific forms:
- Many states provide official forms (often free)
- Available from state health departments or attorney general offices
- Guaranteed to meet state legal requirements
National forms:
- Five Wishes (widely accepted, available at FiveWishes.org)
- National Hospice and Palliative Care Organization forms
- AARP resources
Attorney-prepared documents:
- Customized to specific wishes
- May be part of estate planning package
- Helpful for complex situations
Step 4: Complete the Document
Fill out the form while your parent has mental capacity:
- Be specific about preferences for each treatment type
- Include scenarios that matter most to your parent
- Add personal statements explaining their values and reasoning
- Don't leave sections blank—ambiguity creates problems
Step 5: Execute Properly
State requirements vary, but typically include:
- Signature: Your parent must sign while mentally competent
- Witnesses: Usually two adult witnesses required
- Notarization: Required in some states
Who CANNOT be a witness (varies by state):
- The healthcare agent
- Healthcare providers treating your parent
- Family members or heirs
- Anyone who would benefit financially from your parent's death
Step 6: Distribute Copies
Make sure the living will is available when needed:
- Healthcare agent: Give them a copy and discuss it
- Primary care doctor: Ask them to add it to medical records
- Specialists: Any doctors treating serious conditions
- Hospital: If your parent is admitted, bring a copy
- Family members: Key family members should know it exists and where to find it
- Attorney: If part of estate planning documents
Keep the Original Safe but Accessible
Store the original in a known, accessible location—NOT a safe deposit box (which may be hard to access in emergencies). A fireproof home safe or with important papers that family knows about is better. Also consider registering with your state's advance directive registry if available.
Common Living Will Mistakes to Avoid
Being Too Vague
Problem: "I don't want extraordinary measures" or "No heroic efforts."
Solution: These phrases mean different things to different people. Specify exactly which treatments you do and don't want.
Ignoring the Healthcare Proxy
Problem: Creating a living will without also naming a healthcare agent.
Solution: The living will can't anticipate every scenario. A healthcare agent can make decisions for situations the living will doesn't address.
Not Discussing with Family
Problem: Family members don't know the document exists or disagree with the choices.
Solution: Have conversations with family about your parent's wishes. Explain the reasoning behind their choices. This reduces conflict later.
Forgetting to Update
Problem: The living will reflects wishes from years ago that may have changed.
Solution: Review the living will every few years or after major life events (serious illness, spouse's death, religious conversion).
Not Giving to Healthcare Providers
Problem: The living will sits in a drawer at home while your parent is in the hospital.
Solution: Distribute copies proactively. Bring a copy to any hospital admission. Make sure it's in medical records.
Having the Conversation with Your Parent
Starting this conversation can be uncomfortable. Here are approaches that work.
Opening the Conversation
Try starting with:
- "I've been thinking about my own wishes and wondered about yours..."
- "Remember when Aunt Helen was in the hospital? It made me think about what you'd want..."
- "I was reading about advance directives. Have you ever thought about this?"
- "The doctor asked me if you had a living will..."
Questions to Explore
- "What does a good quality of life mean to you?"
- "Are there conditions where you'd say 'that's not living'?"
- "How do you feel about being kept alive by machines?"
- "What matters most to you about how you spend your final days?"
- "Would you want to be at home if possible?"
Tips for a Productive Conversation
- Choose the right time: Not during a crisis or when anyone is upset
- Listen more than talk: This is about their wishes, not yours
- Don't argue: Even if you disagree with their choices
- Spread it out: Don't try to cover everything in one conversation
- Take notes: Memory is imperfect; write down what they say
- Follow up: "Last time you mentioned... I wanted to make sure I understood..."
Religious and Cultural Considerations
Faith traditions and cultural backgrounds often influence end-of-life decisions.
Catholic Perspectives
The Catholic Church generally:
- Supports refusing "extraordinary" means of prolonging life
- Requires "ordinary" care (food, water, comfort)
- Has specific guidance on artificial nutrition/hydration (complex)
- Encourages consultation with a priest or hospital chaplain
Jewish Perspectives
Jewish tradition varies by denomination:
- Orthodox Judaism often favors preserving life at all costs
- Reform and Conservative Judaism may allow more flexibility
- Consultation with a rabbi familiar with medical ethics is recommended
Protestant Perspectives
Most Protestant denominations:
- Support individual autonomy in these decisions
- Encourage prayer and spiritual discernment
- May have denominational guidance documents
Islamic Perspectives
Islamic teaching generally:
- Forbids actively hastening death
- May allow withdrawing futile treatment
- Consultation with an imam knowledgeable in medical issues is advised
Buddhist Perspectives
Buddhist approaches often:
- Value awareness and consciousness at death
- May prefer less medication that clouds the mind
- Emphasize peaceful, mindful dying
Whatever your parent's tradition, speaking with religious leaders about their specific situation can provide guidance and peace of mind.
Frequently Asked Questions
Can a living will be overridden?
A properly executed living will is legally binding. However, there are situations where it might not be followed:
- If the document is unclear or doesn't address the specific situation
- If healthcare providers don't know it exists
- If family members challenge its validity in court
- If religious-affiliated hospitals have policies that conflict (they should transfer the patient)
The best protection is a clear document, proper distribution, and family discussions that prevent disputes.
How often should a living will be updated?
Review the living will:
- Every 3-5 years at minimum
- After any serious illness or hospitalization
- After death of a spouse or close family member
- If the healthcare agent can no longer serve
- When your parent's wishes change
Many people find their views on end-of-life care change as they age or experience health issues.
What if my parent has dementia—is it too late?
It depends on the stage:
- Early dementia: Your parent may still have capacity to create or update a living will with appropriate support
- Moderate to severe dementia: Likely too late for a new living will, but a healthcare agent can still make decisions
Even without a living will, the healthcare agent (or if none, next of kin) can make decisions based on what they believe your parent would want, considering their known values and past statements.
What's the difference between a living will and a DNR order?
Living will: A document your parent creates that expresses their wishes about various end-of-life treatments.
DNR (Do Not Resuscitate) order: A medical order signed by a physician that tells healthcare providers not to perform CPR. A DNR is often based on wishes expressed in a living will.
If your parent wants a DNR, they should discuss it with their doctor, who can write the order. Some states have POLST (Physician Orders for Life-Sustaining Treatment) forms that are medical orders based on living will preferences.
Will the living will follow my parent if they travel or move?
Most states honor living wills from other states, but requirements vary. To maximize portability:
- Use a widely recognized form like Five Wishes
- Carry a copy when traveling
- If your parent moves permanently, create a new document under the new state's laws
- Consider registering with national advance directive registries
Next Steps
- Start the conversation: Talk to your parent about their values and wishes
- Get the right form: Find your state's official form or use Five Wishes
- Complete it together: Help your parent fill it out, but let them make the decisions
- Execute properly: Make sure it's signed, witnessed, and notarized as required
- Distribute copies: Doctors, healthcare agent, hospital, family
- Complement with healthcare proxy: Name someone to make decisions the living will doesn't address
- Review periodically: Update as needed when circumstances or wishes change
A living will is a profound gift—to your parent, who gets to control their own care, and to your family, who won't bear the burden of guessing what your parent would want during the worst possible moments.