A living will is a statement that you make telling others your wishes about your medical care if a time ever comes when you are near death and can't make your own decisions. You don't even have to write the statement down, you can just tell people what you want, but it's better to go ahead and put your wishes in writing. You may write them down in a letter that you share with your family and doctor, but it's even better to fill out and sign a form that you can date, have witnesses sign and keep on file. You should also name someone to make decisions for you if you are unable to do so yourself with a document that's called a "healthcare power of attorney."

A "power of attorney" is a legal document in which you authorize another person, called an agent, to act on your behalf. An agent can be anyone you trust who is willing and able to serve in a time of need. If you became too ill or disabled to manage your own affairs, you'd still have bills to be paid and checks to be cashed. Your power of attorney authorizes an "agent" to handle these matters for you. An agent can also be given the power to authorize medical treatment if the patient is unable to do so. In this case, the agent is called a "health care proxy." An agent can also be called a "representative" or a "surrogate" as well as a proxy. They all mean the same thing -- someone you have named to act on your behalf when you can't speak for yourself.

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Your will provides instructions on the distribution of your property and personal effects after you die. A living will (an advance directive) provides information about health care decisions while you're still alive.

You may state any preferences you have in your living will. If you document your choices, choose an agent, and discuss your choices with your agent while you are capable, your choices should be followed if you become incapable. The important thing is that you communicate your wishes to the people who care for you. When my father was dying, he didn't have a living will. I would have felt a lot better about the decisions we had to make if I had known what he really wanted. Then I would have felt like I was honoring his own plan, instead of trying to guess what he'd say if he could. If and when I'm in a life-threatening situation, I know my family will benefit from my advance directive. I believe that knowing my preferences will make a hard situation a little easier for them.

You could say to someone, your father for example, "If you were too sick to talk to your doctor about your treatment, who would you want to speak for you?" You can then ask, "Do you have any special wishes you'd like us to know about?" It helps to talk about real life situations, for example, the deaths of relatives or friends where decisions had to be made.

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By law, a doctor or other health care provider must follow a patient's directive. If you and your doctor don't see eye-to-eye about medical treatment, you may want to consider other options, such as getting another opinion or changing doctors.

No adult is too young to complete an advance directive. In Pennsylvania, you may sign a formal advance directive at age 18. (You may be younger than 18 if you are married or a high school graduate.) A young healthy person may want to name someone to speak for him if he were suddenly unable to speak for himself. An example would be someone who suffers a head injury in an accident and is fully expected to recover, but, for a period of time is unable to speak for himself.

It's best to choose an agent or proxy when you are well. Choose someone you trust, a relative or close friend, to make your health care treatment decisions when you cannot make them yourself.

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Your agent speaks for you only when you cannot speak for yourself. If you regain the ability to make your own decisions about your care, you will speak for yourself again.

Your surrogate is expected to make the same decisions that you would make for yourself. Make sure that your agent understands your wishes and is someone who will honor and follow your plan.

You should give a copy of your advance directive to your doctor and, if you have completed a healthcare power of attorney, to your agent. Tell your loved ones that you have written this document and discuss your choices with them and with others, such as your attorney and clergy person. Keep a copy in an accessible but secureplace, such as a desk or dresser drawer. Note that a copy kept in a safe deposit box may not be accessible when needed.

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Even if you have talked to family members about your wishes, and even if you have given someone your power of attorney, the appointment of a health care agent is recommended. If you appoint an agent who knows you and your values, it is more likely that your wishes will be honored. Loved ones often do not know a person's views without a special discussion. Then it is very important to document your discussion in writing. In times of stress, family members may disagree on or not remember what was said in the past. So having something in writing can help everybody during a tough time.

An advance directive defines the medical care you wish to receive if you are terminally ill or in a state of permanent unconsciousness, and goes into effect only if you cannot make your own decisions. It does not keep you from getting medical care or the procedures that you choose to receive. Relief from pain and discomfort should always be provided.

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Life-sustaining treatments such as cardiopulmonary resuscitation, machine-assisted breathing and kidney dialysis are usually considered to be beneficial, but there can be times when they are a burden. For example, when my father was dying, doctors were able to keep him alive with transfusions. Eventually, our family understood that the transfusions were not improving his chances of survival. In fact, they were making his death, and his suffering, take longer.

Life-sustaining treatments such as cardiopulmonary resuscitation, machine-assisted breathing and kidney dialysis are usually considered to be beneficial, but there can be times when they are a burden. For example, when my father was dying, doctors were able to keep him alive with transfusions. Eventually, our family understood that the transfusions were not improving his chances of survival. In fact, they were making his death, and his suffering, take longer.

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There are six requirements:
1. 1. You do not need a lawyer or a notary to complete an advance directive in Pennsylvania, but it must be must be signed and witnessed.
2. 2. You must be at least 18 years old or if under 18, married or a high school graduate.
3. 3. You can add personalized instructions.
4. 4. You may revoke an advance directive at any time.
5. 5. If you are pregnant, restrictions regarding unborn fetuses may cause advance directives not to be honored.
6. 6. Ambulance personnel are required by law to attempt resuscitation unless an approved, out-of-hospital "do not resuscitate" (DNR) order is observed with the person.

You can change your mind, change your living will and/or change your agent at any time. In fact, it's important to review your advance directives regularly, and to tell your doctor and your family and/or agent when you have made changes. If you write a new advance directive, remember to replace all the old copies with the new one.

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It's important to remember to focus on what the person said he or she wanted, not what you would want. That is the duty of the agent. If you don't think you can carry out the wishes of someone who has named you as an agent, you should ask them to name someone else.

If you are unable to make decisions for yourself and don't have an advance directive, the decision will be left to your family, your doctor and possibly the courts. Without written guidance, family members may be confused or disagree about what care to give you. Your wishes may not be followed. If there is not an advance directive, many states have laws that say which family member can speak for the patient. Without such laws, doctors usually turn to a patient's close family members for decision making. But it is still important for people to be talking together to reach good decisions.

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Since 1990, hospitals have followed a federal law called the "Patient Self-Determination Act." It was designed to protect and support your right to make decisions about your medical care. As an adult you have the right to:
1. 1. Receive a clear explanation from your doctors about your diagnosis and treatment options.
2. 2. Accept or refuse medical treatment.
3. 3. Tell others what medical treatment you do or do not want in the future.
4. 4. Appoint someone to make your medical decisions for you if, in the future, you cannot make those decisions yourself.
5. 5. Make decisions about your health care by telling your family, close friends, doctor, nurse, or others, or by putting your directions in writing.
And,
6. 6. Change your mind about your decisions at any time.

Take Charge Online is a project of the Take Charge of Your Life Partnership, a nonprofit organization located in Western Pennsylvania. Our mission is to educate, support and empower all people to deal with end-of-life issues.

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My name is Cynthia Pearson. After helping to care for two family members in their last months, I compared notes on my experiences with my friend since childhood, Peggy Stubbs, who cared for her dying mother in her home. Peggy and I had no medical training -- we just wanted to make our loved ones comfortable. But we felt unprepared, and decided to write a book that would help other caregivers. After our book, "Parting Company," was published in 1999, we joined with others in our community to create programs to "educate, support and empower all people to deal with end-of-life issues."

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