The COVID-19 pandemic has made many people much more aware of health concerns. Over the past months the media and medical providers have been reminding us just how important it is to have completed the two parts of our Advance Directives, the Health Care Proxy and the Living Will. People who have already done so say they feel a sense of relief. They’ve made decisions about the type of medical care they want, they’ve put it in writing, and they’ve alerted their family and medical providers.
However, COVID-19 is a game changer. The idea behind a Living Will is that an individual, other than a physician, can decide whether or not to accept medical treatments that only prolong life, even in circumstances when there is no possibility of a recovery. One key decision about life support treatments centers on cardiac resuscitation and artificial ventilation. Many people, especially health professionals, have stated in their Living Wills they don’t want to be resuscitated. But with the Coronavirus, it’s become obvious that the use of mechanical ventilation can mean the difference between life and death.
What does this mean for you? It’s time to really understand the language used in the Living Will. In the New York State Advance Directive Living Will, read the section about Life Sustaining Treatment choices. If you check box (a) Choice: “Not To Prolong Life”–this is followed by the sentence, “ I do not want my life prolonged if I should be in an incurable or irreversible mental or physical condition with no reasonable hope for recovery.” In such instances, do not resuscitate becomes a clear choice for many people.
However, in light of the threat posed by a serious viral infection, you might want to consider making an addition to your Living Will that reflects current understanding about the successful use of life support treatments in patients with COVID-19. Including a COVID clause does not require a lawyer. But any changes you make regarding your wishes for medical care should be reviewed with your medical providers and loved ones.
Here is an example of a clause that addresses the concerns discussed in this article. Please feel free to copy, sign, and attach it to your current Living Will document:
ADDITIONAL TREATMENT PROVISIONS FOR MY LIVING WILL
I have clearly indicated in my Living Will the circumstances in which I do not want my life prolonged.
However, given the recent outbreak of a number of deadly viral infections, I would like to make the following additions to my Living Will.
In the event that until now I have been reasonably healthy and any medical conditions I might have are under control at this time, should I be diagnosed with a life-threatening viral illness, I would want my medical providers and my health care proxy to know the following:
If my mental and physical state is deteriorating BECAUSE OF A DEADLY VIRAL INFECTION, the prognosis is grave, and there is evidence that I may not survive without critical care treatment interventions–I WOULD WANT A TRIAL PERIOD OF THE FOLLOWING TREATMENT OPTIONS.
- Antibiotics or any medicine needed to treat a life-threatening infection
- Appropriate respiratory therapies, including mechanical ventilation, temporarily needed to eliminate severe respiratory distress
- Cardiac resuscitation if my heart stops beating
- Dialysis if kidney function deteriorates
If my condition does not improve within a reasonable time frame for such treatment to normally take effect or it becomes apparent that continued treatment is causing irreversible physical or mental damage, I would like to have the critical care treatments discontinued and replaced by whatever type of comfort care is needed to relieve any discomfort and allow nature to take its course.
(Signed and dated by you)
Written by Carolyn Van Ness, a retired Women’s Health Nurse Practitioner with experience as a medical journalist and author. Currently her priority is end-of-life education through her efforts as a Death Doula, Death Cafe member, and Hospice volunteer.