Advance Directive vs. Living Will: Understanding the Difference for Medical Decisions

We all face the possibility that someday, our health or age may lead to a scenario in which we can no longer speak for ourselves. Advance directives and living wills do it for us when there is no way to express our health-related wishes. No matter your age or current health, we can never predict when we might find ourselves in a situation where we might need an advance directive vs. a living will. That unknown makes advance directives and living wills crucial planning tools for anyone.

But, understanding the difference between an advance health care directive and a living will can be challenging. There’s a good reason for that, too. These two legal concepts cover a lot of the same subject matter, and there are a lot of similarities between an advance medical directive vs. a living will. However, there are differences that we will cover in-depth with this guide.

The goal is to clearly understand what differentiates a living will from an advance directive by the time you've read to the end. You’ll also have a good idea of how each of these documents can benefit you, your loved ones, and your future. So, what's the difference between an advance directive and a living will? Let’s take a look.

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Defining the Difference Between Advance Directive and Living Will

What is the difference between a living will and an advance directive? The main difference between a living will and an advance healthcare directive lies in the subject matter each cover. These legal documents enable you to make your healthcare preferences known to healthcare providers ahead of time. They are also both tools to help you avoid disagreements, legal battles, and unwanted medical treatment in the event you cannot speak for yourself. As such, they both accomplish many of the same things. However, a living will is just one type of advance directive.

An advance directive is a label given to a kind of document that outlines your wishes in advance of certain events.

An advance directive can also come in handy if it includes a medical power of attorney. A medical power of attorney is a document that is part of your advance directive that identifies a trusted individual to represent your wishes and make medical decisions on your behalf. They have the power to speak with your healthcare providers and enforce your preferences.

As if to make things even more confusing, the difference between a living will and an advance directive will vary from state to state, so it’s always a good practice to familiarize yourself with the rules in your state before signing these documents.

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What is a Living Will?

A living will is a legal document that is a type of advance directive. This document outlines your wishes in specific medical situations. In it, you can list certain types of medical treatments you are okay with while also listing others you do not give consent to undergo. These decisions may include life-support, pain medications, surgeries, experimental treatments, etc. In the event you can’t make your preferences clear, your healthcare providers, including doctors, nurses, surgeons, therapists, etc., will confirm your wishes with your living will.

A living will serves as your voice if you have Alzheimer’s or if you’re ever in a coma. Additionally, it instructs your healthcare providers on what to do if you ever require life support.

A living will includes the following areas:

  • CPR is a treatment method used when your heart has stopped beating. Your living will can state whether you would want to be resuscitated with this method. You may also include your wishes regarding defibrillators, which use electric shock to restart the heart.
  • Medications are often required in many different scenarios. Antibiotics can treat infections, anti-anxiety medications can produce relaxation, and pain meds can reduce discomfort. Your living will can outline which drugs you’re okay with and how long you would wish to take them before ending the treatment.
  • Mechanical ventilation can be extremely uncomfortable, but it can keep you alive in some cases. A ventilator does your breathing for you when you cannot breathe independently. How long would you want to be on a ventilator? Do you give your consent to be put on one? These choices you’ll want to outline in your living will.
  • Artificial feeding is a process through which your body is supplied with nutrients it needs to live when you can’t feed yourself. Your living will should clarify if you want to be fed by tube and how long.
  • Palliative care is a branch of medicine in which comfort and quality of life is the primary concern. Often this comes in the form of pain management and happens when there is no hope of a full recovery. In your living will outline your wishes for pain management, tests, medication, and where you would like to be to live out your final days.
  • Dialysis performs the functions of your kidneys if they cannot fulfill those functions correctly. During this procedure, a machine filters out your blood and pumps it back into your body. Clarify if, when, and for how long you would want dialysis.
  • Do you want to donate your organs? The transplant waitlist is unsustainable in most parts of the United States, so you may wish to donate your organs. Conversely, you may not feel comfortable with this for personal or spiritual reasons. Your living will protect your wishes.
  • Body donation - you may wish for your body to be donated to science. Donated bodies can be highly beneficial in furthering our understanding of medicine, health, psychology, and even criminal investigation. If it is your wish that your body is used to support any of these fields, you can make that known in your living will.
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What is an Advance Directive?

An advance directive vs. a living will is a much broader term. It encompasses several different documents, including a living will. Any legal document covering your decisions and wishes about your future medical care is considered an advance directive.

If you are in a coma, suffer a stroke, suffer from Alzheimer’s or dementia, your advance directive will be activated and referenced by your healthcare providers.

Your advance directive may include:

  • Your living will
  • Your medical power of attorney
  • Medical orders including a DNR or POLST

Let’s take a closer look at some of these documents.

Medical Orders

Medical orders are advance directives that clarify your wishes regarding life-sustaining procedures and treatments. A DNR or Do-Not-Resuscitate order and a POLST or Portable Order for Life Sustaining Treatment order are two different types of medical orders encompassed by the term advance directive.

A DNR is a document that outlines your wishes regarding life-saving treatment such as CPR or defibrillators. Both of these treatments aim to restart the heart if it has stopped beating, and your DNR order can outline how long a medical caregiver can perform this treatment on you if you want to be resuscitated at all.

A POLST contains instructions for medical personnel regarding many different treatments, including CPR and pain management, medical interventions, antibiotics, feeding tubes, etc. Those suffering from terminal or chronic illnesses are often asked to complete a POLST.

Medical Power of Attorney

Sometimes referred to as a healthcare power of attorney or durable power of attorney for health care, a medical power of attorney is a document that identifies someone you trust to represent your medical wishes when you are unable to do so yourself. A medical power of attorney grants the named individual the ability to make medical decisions on your behalf.

Choosing a medical power of attorney can be a challenge because you’ll want to select someone you can trust, but you’ll also need someone with the ability to set aside their personal feelings and make decisions as your wishes would dictate. You also have to ensure you select someone who is a legal adult in your state.

Your power of attorney can be:

  • Your spouse or partner
  • A parent
  • A sibling
  • A child as long as they are of age
  • Extended family member
  • Friend
  • A peer from your place of worship

Once you’ve chosen the person you want to give your medical power of attorney to, fill them in on all of your wishes regarding your medical care so they know how to represent you if you can’t speak for yourself.

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Living Will vs. Advance Medical Directives and Ability to Enforce

For certainty that your healthcare providers will follow your wishes, a medical power of attorney and, therefore, an advance directive is your best option. A living will is a document that outlines your wishes and is consulted when you can’t use your voice. However, a medical power of attorney provides for a thinking, reasoning human being to represent your wishes, covering any scenarios you may not have planned for.

Living wills also may not be enforceable in all states across the US. You may also find your living will be rendered useless when your healthcare situation is not something specified in your living will. That’s when the medical power of attorney can fill in, assess the situation and represent your wishes.

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Living Will vs. Advance Healthcare Directive: Should You Have Both?

Many people find themselves confused about whether to choose an advance health care directive vs. a living will. Knowing the difference between a living will and an advance medical directive is just part of it. A living will is specific and only covers your healthcare wishes in certain circumstances that you have laid out in the document. No one can plan for every possible healthcare situation. As such, it can be beneficial to have a living will and an advance directive, including a medical power of attorney, to make sure your wishes are represented even when you face the unknown.

Your living will can be included in your advance directive alongside your power of attorney and any medical orders you have filled out.

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Creating and Updating Advance Directives and Living Wills

Now that you know the difference between an advance directive and a living will, how do you go about creating them? Advance directives are legal documents that need to be in writing to be legal. From state to state, forms for advance directives and living wills are going to vary. The requirements for ensuring the legality of your documents will also change from state to state. In some states, witnesses are required, while in others, you may have to have certain documents notarized. It’s a good idea to look up the rules and forms in your state.

Once you have your forms and understand the rules and the difference between a health care advance directive and a living will, fill your forms out according to those guidelines. When you have completed that step, it’s good to go over the wishes in your advance directive with your doctors and your medical power of attorney.

Hang onto the originals yourself. It’s always best to keep them somewhere tucked away but safe. A locked box or filing cabinet in your home may be the best choice. You will also want to give your doctor and other healthcare providers a copy of your living will and any other advance directives you’ve filled out. Your medical power of attorney will also require a copy of these directives.

You may also wish to pop a card in your wallet that indicates you have advance directives as well as the name of your doctor and medical power of attorney. Bring a copy of your advance directives when you travel out of state and out of the country.

Be sure to keep your advance directives up to date with any changing opinions and wishes you may have. Every ten years is a good start, but you may also consider updating your advance directives when you find your positions changing on some of the specifics in the document.

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