Living Will or Medical directive

The living Will is about your choices at the end of life, such as mechanical ventilation, artificial nutrition, and hydration (ANH). for Muslims, the Living Will must meet the Islamic bioethics requirements under Shariah. Make sure your voice is heard and respected concerning your wishes, values, and beliefs. Discuss what you want and discuss your life-refusing or prolonging care (including "do not resuscitate - DNR") with others. The living Will has different terminology in different countries, such as Personal directive, Advance directive, Advance care directive, Advance care planning, Medical directive or Healthcare directive, Healthcare advance directive, Healthcare proxy, or advance decisions. We will use a word "Living Will" and "Proxy" instead of other names in our discussion. Living Will represents you in a comatose, irreversible conscious coma, vegetative state (traumatic or nontraumatic), brain-dead, Cardiac arrest, locked-in state, cognitive impairment, futility, respiratory failure, terminally ill, paralyzed with receptive and expressive aphasia in a terminal state, or inability to communicate in critical illness, disability, or mental incapacity. You have the right to withhold or withdraw your treatment through Living Will as long as it is not contrary to the law. Living Will enables your rights to be respected and preferences about organ donations, transplantations, etc. Many people rely on Islamic Will to cover postmortem or autopsy-related wishes, which usually does not happen because Islamic Will does not become effective until death. Also, the term Living Will is not appropriate under the Islamic faith because humans cannot decide their Living or Death, which is always from Allah (Subhanahu Wa Ta aala). You can make choices in medical directives to prevent the desecration or mutilation of the body. A doctor who pulls the tube out without consent is as bad as murdering. The Patient often signs the consent form in a drowsy situation without fully understanding the impact of surgery or treatments in front of nurses in the absence of a Living Will. In some cases, matters can go to court upon disagreements of family members in the absence of a Living Will. The Living Will is a must, whether young or old, because of unknowns (i.e., accidents, pandemics, disasters, sickness, etc.).

Mentally capable

It is a state a person can understand the information and communicate that is relevant to making a personal decision and the ability to appreciate the reasonably foreseeable consequences of the decision.

Personal matters

It may include terms such as healthcare, accommodation, with whom the person may live and associate, social, educational, religious, cultural, and employment participation.

Advance statement

An advance statement term is applicable for United Kingdom residents, which allows you to make general comments, describing your wishes and preferences about future care should you be unable to make or communicate a decision or express your choices. You may want it to reflect religious or other beliefs and essential aspects of your life. You can include food and drink preferences, the type of clothes you like to wear, music, TV or DVD choices, or whether you want a bath or a shower. An advance statement is not legally binding, but those making a ‘best interests’ decision on your behalf should consider its contents when you cannot tell them what you would like.

Artificial Nutrition and Hydration (ANH)

Artificial nutrition and hydration, also called ANH or tube feeding, may be offered to someone unable to swallow food and liquids without choking (REF. Hospice foundation of America).

Mental capacity act (MCA)

The MCA applies to residents of the United Kingdom and aims to empower and protect people who cannot make decisions for themselves by providing a legal framework and process to follow when making 'best interests decisions. MCA refers to "Advance decisions." Advance decisions to refuse treatment that is both valid and applicable under the requirements of the Mental Capacity Act will be legally binding for everyone involved in the care of the individual.
 

Lasting Power of Attorney

The Mental capacity act applicable to the United kingdom's residents introduced the Lasting powers of attorney (LPA) system, which replaced the previous Enduring powers of attorney. You can make LPA for financial decisions (which is equivalent to "Power of Attorney" is a general term) and LPA for health and care decisions (which is equal to "Living Will"). If you have or intend to have an advance decision to refuse treatment and LPA for health and care decisions, it is essential to consider their inter-relationship.
 

Advanced care planning (ACP)

ACP is preparing for likely scenarios near the end of life. It may include assessing and dialogue about a person’s understanding of their medical history and condition, values, preferences, and personal and family resources.
 

Mentally capable

It is a state a person can understand the information and communicate that is relevant to making a personal decision and the ability to appreciate the reasonably foreseeable consequences of the decision.
 

Personal matter

It may include terms such as healthcare, accommodation, with whom the person may live and associate, participation in social, educational, religious, cultural, and employment activities, legal matters, or any other matter prescribed by the regulations.

Treatment

It is a medical procedure to be carried out by a healthcare practitioner to cure sickness.
 

Personal care

It refers to the daily living needs of individuals, such as living arrangements, diet, clothing, hygiene, exercise, and safety.
 

Comfort care

The non-medical or medical care that can keep you comfortable and manage your pain but will not cure your illness.

Palliative care

Traditionally, palliative medical care is provided during the last few months, weeks, or days of a person's life. In reality, however, most people die unexpectedly, not within a defined timeframe, and often without being identified as a palliative. For these reasons, the current best practice is to provide a palliative approach to care to begin earlier within a person's journey with an illness.
 

Anatomical gift

It refers to the donation of an individual's body organs to medical science after death which provides an opportunity for future health professionals to study human anatomy and develop an appreciation of the form, function, and beauty of the human body. It may also include allowing one's organs to be removed immediately after death for medical purposes, usually transplanted into another ill person—for instance, your wishes to donate eyes, kidneys, etc. Making an anatomical gift is your personal choice, and no country law forces you to do that.
 

Cardiopulmonary resuscitation (CPR)

It is an emergency procedure used to revive someone when their heart and lungs stop working unexpectedly.

Natural death

Natural death is a medical term used for life-extending measures such as cardiopulmonary resuscitation (CPR). These orders emphasize patient comfort and pain management instead of life extension.

Locked-in state (LiS)

People with locked-in syndrome are conscious, alert, and have their usual cognitive abilities (thinking and reasoning), but they're unable to show facial expressions, speak or move. People with LiS can hear and typically communicate through purposeful eye movements, blinking, or both (REF. Cleveland Clinic).

Vegetation state

A vegetative state is when a person is awake (and eyes opened unconsciousness) but showing no signs of awareness. On recovery from the coma state, VS/UWS is characterized by the return of arousal without signs of awareness. In contrast, a coma is a state that lacks both awareness and wakefulness (REF. Brain Foundation).
 

Life support or Life prolonging medical interventions

These are healthcare treatments like tube feedings, ventilators (breathing machines), kidney dialysis, medications, and cardiopulmonary resuscitation.
 

Psychosurgery

Any medical procedure that, by direct or indirect access to the brain, removes, destroys, or interrupts the continuity of histologically normal brain tissue. Or that inserts indwelling electrodes for pulsed electrical stimulation to alter behavior or treat psychiatric illness. However, it does not include neurological procedures used to diagnose or treat intractable physical pain or epilepsy where those conditions are demonstrable.

Comma or Comatose

It is a medical condition profound state of unconsciousness with no reasonable expectation of regaining consciousness. In such a state, a patient is alive (with eye-closed unconsciousness) but unable to react or respond to life around us and is not expected to awaken from that comatose condition.
 

Dialysis

It is a medical procedure that cleans your blood when your kidneys can no longer do so.
 

Feeding tube

It is a way to feed someone who can no longer swallow food. It is a small plastic tube that carries liquid food inserted through the nose or directly into the stomach or intestines.
 

Intensive care unit (ICU)

It is a unit in a hospital where people kept alive using machines (such as a breathing machine or ventilator) and proper intravenous medications to support the heart.

Intravenous line (IV)

It is a way to give a person fluids or medicine. A hollow needle attached to a narrow tube is placed in a vein in the hand, arm, or another location.
 

Tracheostomy

It is a surgical procedure to create an opening into your windpipe through your neck.

Transfusion

It is a treatment when a person is given blood or blood products through an intravenous line.

Ventilator

It is a machine attached to a tube placed down the windpipe, helping people when they can not breathe independently.
 

Autopsy

It is also called a post-mortem examination, abduction, necropsy, or autopsia cadaverum. It is a highly specialized surgical procedure that consists of a thorough review of the dead body by dissection to determine the cause and manner of death or evaluate any disease or injury present for research or educational purpose.

Truths are always thorny, but that's the reality of our life.

The aim is to respect human dignity by providing clinically indicated and ethically appropriate care and seeks to understand patient values regarding care provision through the wishes outlined in the document.

There are three areas Personal care, Health conditions, and non-financial you may include in your living will.

Personal care

It may include Cloths, comfort care or measures, continuing care, nutrition, shelter, and daily needs (meals, laundry, dressing, mobility, etc.).

Health conditions

It may include stroke, Dementia, permanent comma or other terminal illnesses, allow natural death, antibiotics, blood transfusions, chemotherapy, Intravenous therapy (IV), intubation, Kidney dialysis, life support with medical interventions, palliative care, radiation, resuscitation, tube feeding, and surgery.

Non-financial

It will include legal matters such as giving consent to release your medical records etc.

If you do not have a Living Will in place and you lose mental capacity in the future, a family member or friend will be struggling. The health care decisions may delay until a court order can appoint a Proxy. The person designated as your Proxy may not be the person you would like or want to make decisions for you. Additionally, depending on how your financial affairs are set up, mental incapacity could make it virtually impossible for your family or friends to deal with the simplest tasks, such as what medical treatment can be allowable for you.

If you have an accident or become ill and lose your capacity to give instructions, these documents become crucial.

You might be in an irreversible coma, or you're suffering from a terminal illness. You're no longer lucid, and you can no longer express the steps you want taken to preserve—or not to keep—your life. Do you want your heart resuscitated if it stops? Would you instead not be placed on a ventilator even if it means saving your life? All these decisions are essential, which your living Will would answer.

A living will is to deal with how you feel about life-ending versus life-sustaining procedures. It can also address issues of palliative care and organ donation. It allows you to express your wishes in advance when you are still far from sickness and think clearly.

We are all healthy, happy, and enjoying our life. However, we do not know what happens next about our medical conditions, and that's why it is wise to create a living will as soon as you are an adult (or mature minor, subject to state or provincial or territorial legislation).

Many jurisdictions need to have a valid Living Will to be in place before carrying out the end-of-life care. Living Will gives people an opportunity to secure wishes, values, and beliefs. One may have during the end-of-life stage.

You should think about creating your Will as soon as you may have medical conditions such as pain, dizziness, anxiety, etc. Also, when you are going under treatment of dialysis, feeding tube, tracheostomy, transfusion, ventilator, the intravenous line (IV) or you are in intensive care unit (ICU) or before going to minor or major surgeries, before it becomes too late and should you become mentally incapable.

An adult (or mature minor, subject to state or provincial or territorial legislation) or by Proxy who is your spouse, relative, or friend capable of understanding written information. The appointed Proxy should know you well, be willing and able to make complex decisions on your behalf, and be able to be contacted.

In critical health care situations such as you do not recognize you're loved once, relatives or friends and, Doctors feel that you are very close to death and so, this is the time when you want to be kept alive using machines? Does anyone know your wish? And Is anyone appointed to take decisions on your behalf regarding your personal and medical care and treatment you may need? All these may happen when a patient is in a comma, terminal illness, or Alzheimer's kind of situation.

There are typical questions you should ask are below to fine tune your end-of-life wishes.

The living will is the document that expresses your wishes about the medical care you may prefer to take in case of a terminal illness. You have the freedom to pick and choose what you want and do not want, and that way, you may secure your moral or religious wishes. In many religions, it is not allowed to turn off treatment (similarly, if you have a fever and not taking medicine for curing yourself) and let a patient die. The decision about healthcare planning is the very personal choice of an individual. No one stops you from expressing your wishes about how you would like to be taken care of in a comma or terminal illness kind of situation. In summary, please keep in mind to think and discuss the following points while creating your living Will.

It is better to appoint more than one Proxy, in case if the first Proxy may not be able to act then the second Proxy (substitute or alternate) can perform for carrying out wishes.

If you do not have a Proxy, then the government appoints a proxy to decide on your behalf. There is specific legislation for selecting Proxy and may differ from one jurisdiction to another. It may include relatives from the hierarchy (legal guardian, spouse, child, parent, siblings, grandparent, aunt, uncle, niece, nephew, other relatives or public trustee, etc.) outlined in the law that will ask to make decisions for you. They must make decisions based on knowledge of your wishes, values, or verbal instructions. If they do not know your preferences, they must base the decisions on your best interest. So it is essential to have a conversation with your loved ones or friends you trust about your end-of-life wishes, values, and beliefs.

Your family physician or doctor, other healthcare professionals involved in your care, your lawyer, and other family members or friends should know about your wishes, values, and beliefs. Let your doctor know who you have appointed to be your future Proxy and this will be helpful if you do not have a Proxy named and should happen you to be mentally incapable then above mentioned personal can speak to your future Proxy.

If you do not wish to name anyone to make decisions for you, but want to set out specific instructions for health care providers to use, you can write down the instructions and talk to your healthcare providers. However, it is complicated to write instructions that are specific to every situation where Wassiyyah comes to give your Living Will ready. If your instructions are unclear or not applicable to a particular case, then your healthcare providers would turn to your Decision Maker.

The living Will would come into effect only if you are not capable of speaking for yourself i.e. up on mental incapability. The last version of a living will be in effect and speak about your wishes.

You can also change it as long as you are mentally competent. It becomes irrevocable as soon as you loos mental capacity.

Before changing or canceling your living Will, be sure you have up to date knowledge about your current health condition and the plan for the new health care treatments available to you. Your circumstances change over time, and you may change or cancel or revoke your living Will anytime as long as you are mentally capable. If you want to change or cancel (revoke) your living will, you should destroy all copies of the old living will to avoid any confusion and make a new one. It is not required. However, you can also declare your intention to cancel your living will in writing, signed, and witnessed. It is essential to regularly review and make changes to your living Will when you believe it is necessary.

If it is an emergency situation and time is a concern, the health care providers will proceed with providing treatment. To avoid this situation, you may want to have a card in your wallet indicating you have a living will and that you have named a Proxy, and include his/her contact information.

You may never need your advance care plan – but if you do, you will be glad that you have had these conversations. It is a way to make sure that your voice is there when you cannot speak for yourself.

An Advance Care Plan is more than a document outlining your wishes for care at the end of life. Advance Care Planning is a process of reflection and communication. It is a time for you to reflect on your values and wishes, and to let others know what kind of health and personal care you would want in the future if you become incapable of consenting to or refusing treatment or other consideration.

It means thinking about what is important to you and what you value. Having these conversations and making a plan are ways to give your delegates the confidence to make decisions on your behalf. It is how we care for each other.

The advance care planning is another name for management of living will. The term is popular in Canada and used to guide health care professionals, patients and alternate decision-makers regarding the general intentions of clinically indicated health care, specific interventions, and the service locations where such care will be provided. It also guides healthcare professionals to assist in rapid decision-making in the clinical environment. These conversations allow for a respectful understanding of patient’s wishes concerning general care focus as well as initiation, continuation, and limits of specific interventions. This process will include communication between health care professionals, patients and when appropriate, alternate decision-makers. Once a Goals of Care Designation conversation has been held, and if clinically indicated, a Goals of Care Designation order shall be created by the most responsible health practitioner and documented in the Advance Care Planning/Goals of Care Designation Tracking Record. Reviewing, validating or altering a Goals of Care Designation order occurs when the new circumstances or health issue arise, the location of care changes, the patient or alternate decision maker requests or have a disagreement with the designation.

We provide answers to many other of questions part of the small user guide book comes with your Living Will.

If you create the Islamic will, you must create Living Will as a separate document. You cannot combine Islamic Will and Living Will in one document. However, if you are making Trust, your Living Will can be part of the Trust, and in that case, you do not need to create a separate Living Will.

As the names suggest, the revocable one can be terminated by the principal at any time, while the principal cannot terminate the irrevocable. Living Will is a revocable legal document. However, it becomes irrevocable upon mental incapacity.

Updating Living Will means you need to follow the entire witnessing, signing, and notarization process as soon as you change the previously witnessed and notarized Living Will. You need to update your Living Will in scenarios such as all witnesses die, all executors die, geographically relocated out of the country, and if the testator dies. But you do not need to change your Living Will for changes in marital status (i.e., marriage or divorce), death of Spouse, birth or death of children, job, employer, properties, investments, bank accounts, or business. You can update the Living Will during your lifetime as long as you are mentally capable, but it becomes irrevocable upon mental incapacity.

Scan and send the electronic copy via email to your spouse, trusted family members, friends, Executors, or lawyer. Keep the original copy at home, lawyer's office, or bank safety deposit box. If you are in the continuing care kind of situation or traveling across the world, take a copy with you.

Disclaimer: We have done our due diligence to provide the readers with accurate information. However, liability lies with readers. The laws with regards to a living will differ from one jurisdiction to another, and so please consult the respective jurisdiction's website before making a decision.