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Updated 18 July 2013

Why you need a living will

South Africa’s Living Will Society has been inundated with calls from the public in recent weeks, likely as result of media coverage of Nelson Mandela’s hospitalisation. What is a living will and why do you need one?

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No one wants to think about death, but planning for end of life, in as far as we can, actually helps us come to terms with it better. Drawing up a living will is an important practical part of this process and can bring a sense of reassurance to you and your family.

What is a living will?

Unlike a will, or “last will and testament”, which stipulates certain directives after your death, a living will relates to your end-of-life wishes while you are still alive.

In a living will, you give certain instructions in the event of a grievous medical condition that would render you unable to make or express your own decisions. Living wills are most often used to state that, should there be no reasonable chance of recovery, you do not wish you be kept alive through artificial life support. They are also called “advanced health care directives”.

Why bother with a living will?

Many people don't like the idea of their lives being prolonged when there is no reasonable quality of life or hope of recovery, as in cases where a person is in a vegetative state but is being kept alive with artificial life support.
 
Having a formal document where your wishes are clearly stated can be a gift to family members who otherwise have to make the anguished decision themselves.

Prolonging life unnecessarily is highly distressing for loved ones, and the medical costs involved can place a financial burden on your family. In some cases, patients have been kept alive for years on life support because there was no clear directive about their wishes.

As with a last will and testament, it becomes more important to have one the older we get, but anyone over 18 should consider getting a living will. With regards to potential organ donation, it's especially important that younger people have living wills so that, should they die, their healthy organs can be harvested to give someone else a new chance at life.

How to go about getting a living will

Drawing up a living will is not complex or expensive. You can draw one up yourself, or ask a lawyer to do so – but obviously the latter option will be more costly. An excellent option currently in South Africa is to become a member of The Living Will Society, a non-profit organisation that, for a nominal fee (R80 and R30 for pensioners,) supplies you with pro forma documents and advises you on exactly how to create a legally binding living will. You will also get a wallet card (similar to an organ donor card) and stickers stating you have a living will. Or, you can add the fact you have a living will to a MedicAlert bracelet.

Brigid Raw, Director of the Living Will Society, says that they also play a supportive role, providing backup for members when needed. An attending doctor at a hospital can call them if he or she has questions about your living will, for example, and the Society can liaise between family and medical staff if necessary.

This nominal fee also helps the Society continue with its core work – educating South Africans about the importance of living wills in providing more humane, dignified end-of-life choices. Very few of us have a living will, or even a last will and testament.

Brigid says that it often takes a high-profile case for people to start thinking about their own and family members' end-of-life options.

“We’ve been inundated with calls from the public with Mandela’s hospitalisation being in the news,” says Brigid. She adds that there was a similar peak in calls to the Society when Pope John Paul II was dying in 2005, and chose care at home for his last days.

What a living will can and cannot state

Typical directives in a standard living will would be along the following lines (text is paraphrased from The Living Will Society):

In the event that I can no longer make decisions for myself, and there is no reasonable prospect of recovery from illness or injury expected to cause me severe distress or render me incapable of rational existence, I do not give consent to be kept alive by artificial means, including ventilators, pacemakers or tube-feeding.

I do give consent to receive drugs and intravenous fluids to relieve pain or distress, even if this hastens death.

I do not give consent to attempts at resuscitation, should my heart and breathing stop and my prognosis be hopeless.

A living will in South Africa cannot include directives for euthanasia or physician-assisted suicide i.e. you can ask for treatment to be withheld, but you cannot ask a doctor to end your life, in the event that, for example, you develop advanced Alzheimer’s but are otherwise able to continue living without life support.

Other important points regarding living wills:
  • A living will must be signed by you and two witnesses, in each other’s presence. Witnesses should not be family members, your doctor, or beneficiaries listed in your last will and testament.
  • Ideally, there should be several copies (at least three) which you can give to family members and your doctor to keep. Make sure that anyone who may have to implement your directives knows about your living will and where it is kept.
  • The treating doctor must have access to your living will in order to carry out its directives, and is legally bound to do so. 
  • A living will should not be incorporated into or attached to a last will and testament, as the latter is only acted on after your death and there's a risk that your living will directives may only come to light then. 
Living Will Society contact details:
Website: www.livingwill.co.za
Email: livingwill@3i.co.za
Telephone: 031 266 8511

Image of living will: Shutterstock

 
 
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