Insure that this most important document is immediately available, whenever it's needed, wherever it's needed.

You are among many people interested in taking more control over their health care and well being by determining your life style and the type of wellness care you receive. You can also control what type of treatment you want if you become seriously ill or incapacitated and can no longer make your own health care decisions. In the United States, your right to advance medical directives is protected by the federal Patient Self- etermination !ct. Such directives include living wills and health care pro"ies#durable powers of attorney for health. In $anada, si" provinces %&ritish $olumbia, 'anitoba, (ewfoundland, (ova Scotia, )ntario, and *uebec+ have a living will law. ,ach, however, has its own re-uirements. .or specific $anadian information, click here. ! /iving 0ill, the most basic directive, specifies well in advance whether or not a person is to have his#her life prolonged through artificial or e"treme methods. It goes into effect only when you are no longer capable of making decisions about your medical treatment. /iving 0ills are made more effective when supplemented by a health care pro"y or durable power of attorney for health, naming a relative or friend to act on the patient1s behalf if he#she is unable to do so. 'ost states either have a living will and health pro"y law or recogni2e the validity of these documents. Unfortunately, too often, individuals sign advanced health care directives that are not accessible to their family, health care practitioner, or hospital. !nd, many people live, work, and travel regularly to other states but do not have the appropriate documents for each 3urisdiction.

What is a Living Will and Why Does One Really Matter

4he legal and emotional battles the family of patient 4erry Schiavo endured over her endof-life decisions and removing her life support systems made national headlines. If you know how to make a living will, you can save your loved ones such e"pense and trauma. 0e don1t like to think about such events, but taking the time now to e"press your preferences for medical care and life support can ensure that your loved ones will not be burdened with making difficult medical decisions on their own or through the courts. /iving wills may be easily prepared without an attorney. ! living will sample may also be followed for guidance.

!lthough the term living will may sound like a last will, it doesn1t have anything to do with how to avoid probate of your estate or distribution of your assets to heirs. 4herefore, don1t let the title of an advance healthcare directive form fool you. )riginally, an advance directive form was only used to e"press your wishes regarding healthcare decisions when you are permanently unconscious or have a terminal illness. /ater, what are sometimes referred to as second generation advance directives or third generation advance directives, were developed to allow a person to appoint another in advance to act as their healthcare agent when he or she is incapacitated. It is intended to provide instructions for others to make medical care decisions for you when you are no longer able to make medical decisions for yourself. ! healthcare agent, sometimes called a health care pro"y, patient advocate, surrogate, or health care representative, may also be appointed in advance to make medical care decisions when you are not able to make decisions and healthcare choices for yourself.

!ow to Ma"e a Living Will

! living will form may be provided to your physician and other healthcare providers, allowing them to follow your wishes for medical care. 4he form states whether you wish your life to be artificially prolonged if you are a patient with a catastrophic illness or accident. 4he form must comply with the laws of your state, since the laws vary by state. ! form for a living will may re-uire two witnesses to attest to your signature and#or that the form be notari2ed. 4he form for living will provided on this site will indicate which is re-uired. 0hen living wills are combined with the appointment of a healthcare agent, they are often referred to as advance directives for medical care. If the advance healthcare directive provides for the appointment of an agent to make care and treatment decisions, the agent should not also serve as a witness. 'any forms also allow you to appoint a successor health care pro"y in case the first health care agent is no longer able to serve. 4he person you select as your agent should be someone you trust and doesn1t need to be a family member. 4he representative should be someone who understands and shares your values and lives in your area. /iving wills may also be used to e"press your wishes for organ donations and final arrangements. You may use an e"ample of a living will form for your state, or you may download a statutory living will form that copies statutory language in state statutes. &oth types of living will forms are e-ually valid, since the forms and living will samples offered by US/egal are state-specific and all of our advance medical directive forms are regularly updated to comply with state law. &e aware that many sites offering a living will sample offer the same advance directive form for all states, whether you need a $alifornia living will, .lorida living will, or 4e"as living will, etc. If the advance healthcare directive doesn1t comply with the laws of your particular state, it will not be enforceable. ! healthcare power of attorney or other medical directive doesn1t take effect until a medical e"pert determines you are permanently unconscious. !n advance directive form

may be freely revoked while you are still competent and not incapacitated. ! copy of your advance medical directive form should be provided to any healthcare agent you appoint, your doctor and other healthcare providers, and any close friends and relatives whose cooperation may be needed. Some states also have a living will registry for living wills and other advance health care directives.

Medical #reatment Options $or %ou to Decide &pon

0hen you make an advance directive for healthcare or form for living will, you will need to make medical care decisions in advance. 4he following are some of the medical treatment options and healthcare decisions you should consider if you were to become hospitali2ed in a persistent vegetative state5 ' (ardiopulmonary resuscitation )(*R+ is a method of reviving a patient1s heart by a device that delivers an electric shock to stimulate a heart that has stopped beating. ' ,rti$icial ventilation is a procedure for providing o"ygen to you through mechanical means when you are unable to breathe on your own. ' ,rti$icial nutrition and hydration provides fluid and nutrition through intravenous means or a tube when the patient is unable to be fed. ' Dialysis cleans your blood and maintains proper fluid levels when your kidneys fail. ' *ain medication can ease discomfort for a patient but may affect awareness of surroundings.

Other ,dvance Directives

Some other forms individuals may use to give advance instructions to make healthcare decisions on their behalf and state medical treatment preferences include5

o-(ot-6esuscitate )rder % (6+- this form states your preference not to be resuscitated and instructs healthcare providers not to use $P6 if your heart stops beating. 'ental 7ealth $are irective - the patient may state treatment preferences for mental healthcare, such as consent to psychoactive medication, electroshock therapy, restraint, isolation, or medication in this advance directive.

(onclusion
You can save your loved ones much additional trauma in an already difficult situation by creating advance directives for medical decisions or a living will. &y taking the time to complete a form for a living will, you can have the peace of mind of knowing that your

wishes for medical treatment and life-prolonging procedures will be followed and that those closest to you will be spared from having to make difficult medical care decisions.

History of Living Wills

4oday all 89 states and the istrict of $olumbia recogni2e living wills as legal documents. !dvance directives, also known as living wills, appeared in the :;<9s and have continued to evolve over the last =9 years. !s social awareness grew from personal e"perience, legislators were inspired to legally recogni2e living wills.

1960s
/uis >utner, a notable human rights attorney from $hicago, is credited for creating the original living will in :;<?. !fter e"periencing the long and painful illness of a close friend, he advocated for a document allowing people to e"press their final wishes about using medical life support treatments when nearing death. Inspired by >utner, r. 0alter .. Sackett introduced a bill in .lorida proposing the right to choose whether to use life-sustaining e-uipment. 4his bill was unsuccessful in :;<@ and in :;?A.

1970s
!bout the same time r. Sackett proposed living wills in .lorida a legislator in $alifornia presented a similar bill. &arry >eeneBs terminally ill mother was unable to limit end-oflife treatment, even with a signed power of attorney. >eene introduced his bill in :;?=. 0hen it passed in :;?<, $alifornia became the first state that legally sanctioned living wills. &y the end of :;?8 seven states had already passed similar bills, and =A states had similar bills under consideration. &y :;;C all fifty states had passed living will legislation. )nce passed into law, the door opened for living wills to be challenged in court.

The Courts React

In :;?< the (ew Dersey Supreme $ourt heard the >aren !nn *uinlan case. !t age C: *uinlan lapsed into a persistent vegetative state after ingesting alcohol and valium at a party. *uinlanBs father fought to make legally binding treatment decisions for his comatose daughter. 4he court allowed the withdrawal of >arenBs mechanical ventilation so she could die. 4his :;?< decision included the following conditions5

If patients are mentally unable to participate in health treatment decisions, another person may do so for them If health care decisions may result in the death of a mentally incompetent person then the decisions should be made by families and their physicians, not the courts Decisions must consider the invasiveness of the proposed treatment, and whether or not the patient will ultimately recover All patients have the right to refuse treatment, even if their decision hastens their death

! second landmark case about (ancy $ru2an was heard by the United States Supreme $ourt in :;;9. Similar to >aren !nn *uinlan, a re-uest was made to withdraw life sustaining treatment where there was no hope of recovery. 4wenty-five year old (ancy $ru2an lost control of her car. She was found lying face down in a ditch with no heartbeat or respiration. !lthough $P6 resuscitated $ru2an, she suffered e"tensive brain damage from lack of o"ygen. $omatose, her life was maintained by a feeding tube that provided nutrition and hydration. 0hen the $ru2an case was presented to the courts, they found sufficient evidence to prove (ancy would not have wanted her life sustained, and ordered the feeding and hydration tube withdrawn. &oth of these cases involved young adults who were physically strong, but who were in a persistent vegetative state with no hope of recovery. 4hese cases established separate, but complementary, legal rights5

Quinlan: The ability to appoint a health care proxy (decision ma!er" #ru$an: The right to execute a binding living will

The Schiavo Case ( 00!"

4he *uinlan and $ru2an decisions came into play in .lorida with the case of 4erri Schiavo. /ike *uinlan and $ru2an, Schiavo was only C8 years old when she e"perienced a full cardiac arrest. Surviving resuscitation, but left severely brain-damaged, she was sustained on tube feedings for :8 years. SchiavoBs husband, through his attorneys, succeeded in obtaining a court order allowing the feedings to end. SchiavoBs parents fought this decision unsuccessfully for ? years. 4his conflict resulted in numerous legal actions and fostered public debate on the right to die. !sked to intervene, the United States Supreme $ourt refused si" times to hear the case. 4he U.S. $ongress and the President attempted to enact last minute legislation changing

the forum for the Schiavo case. )n appeal, the .ederal $ourt refused to allow a EbreachE of the 3udicial system, accusing the e"ecutive and legislative branches in overstepping their authority by telling 3udges how to do their 3ob. 4he $ourt stressed that 3udges must guard their independent role as defined by the $onstitution even in the face of overwhelming individual tragedy. !s ruled in :;?<, decisions regarding medical treatment are for families, not the courts.

Conclusion
,arly cases set the stage to establish the right to e"ecute a legally recogni2ed living will. 4he Schiavo case has shown that the right to make personal medical decisions may still be challenged in the future. ! lawyer with e"perience drafting living wills can answer your -uestions today. IS$/!I',65 4his site and any information contained herein is intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.

What is a Living Will

/iving wills gives the person you select the health care Epower of attorneyE if you1re incapacitated and can1t make these decisions yourself.

Why should I ma"e a Living Will

If you1re in a coma or other dire medical situation, your Epro"yE or representative interprets your health care decisions Fives you peace of mind in case anything happens to you

#vance health care #irective

%rom &i!ipedia, the free encyclopedia ('edirected from (iving will" )ump to: navigation, search *(iving &ill* redirects here+ %or the ,-.. film starring 'yan Dunn, see (iving &ill+
!n advance health care directive, also known as living will, personal directive, advance directive, or advance decision, is a set of written instructions that a person gives that specify what actions should be taken for their health, if they are no longer able to make decisions due to illness or incapacity. ! living will is one form of advance directive, leaving instructions for treatment. !nother form is a specific type of power of attorney or health care pro"y, in which the person authori2es someone %an agent+ to make decisions on their behalf when they are

incapacitated. People are often encouraged to complete both documents to provide comprehensive guidance regarding their care.G:H ,"amples of combination documents include the .ive 0ishes and 'y irectives advance directives in the United States.GCH

-ac"ground
The examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject+ /lease improve this article and discuss the issue on the tal! page+ (0eptember ,--1"
!dvance directives were created in response to the increasing sophistication and prevalence of medical technology.GAHG=H )f U.S. deaths, C8I-88I occur in health care facilities.G8H (umerous studies have documented critical deficits in the medical care of the dyingJ it has been found to be unnecessarily prolonged,G<H painful,G?H e"pensive,G@HG;H and emotionally burdensome to both patients and their families.G:9HG::H !ggressive medical intervention leaves nearly two million !mericans confined to nursing homes,G:CH and over :.= million !mericans remain so medically frail as to survive only through the use of feeding tubes.G:AH !s many as A9,999 persons are kept alive in comatose and permanently vegetative states.G:AHG:=H $ost burdens to individuals and families are considerable. ! national study found that5 KIn C9I of cases, a family member had to -uit workJL A:I lost Kall or most savingsL %even though ;<I had insurance+J and KC9I reported loss of GtheirH ma3or source of income.LG:8H Yet, studies indicate that ?9-;8I of people would rather refuse aggressive medical treatment than have their lives medically prolonged in incompetent or other poor prognosis states.G:<HG:?H !s more and more !mericans e"perienced the burdens and diminishing benefits of invasive and aggressive medical treatment in poor prognosis states M either directly %themselves+ or through a loved one M pressure began to mount to devise ways to avoid the suffering and costs associated with treatments one did not want in personally untenable situations.G=H 4he first formal response was the living will.

Living will

'efusal of treatment form

4he living will is the oldest form of advance directive. It was first proposed by an Illinois attorney, /uis >utner, in a law 3ournal in :;<;.G:@H >utner drew from e"isting estate law, by which an individual can control property affairs after death %i.e., when no longer available to speak for themselves+ and devised a way for an individual to e"press his or her health care desires when no longer able to e"press current health care wishes. &ecause this form of KwillL was to be used while an individual was still alive %but no longer able to make decisions+ it was dubbed the Kliving will.LG:;H ! living will usually provides specific directives about the course of treatment that is to be followed by health care providers and caregivers. In some cases a living will may forbid the use of various kinds of burdensome medical treatment. It may also be used to e"press wishes about the use or foregoing of food and water, if supplied via tubes or other medical devices. 4he living will is used only if the individual has become unable to give informed consent or refusal due to incapacity. ! living will can be very specific or very general. !n e"ample of a statement sometimes found in a living will is5 KIf I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.L 'ore specific living wills may include information regarding an individual1s desire for such services such as analgesia %pain relief+, antibiotics, hydration, feeding, and the use of ventilators or cardiopulmonary resuscitation. 7owever, studies have also shown that adults are more likely to complete these documents if they are written in everyday language and less focused on technical treatments.GC9H /iving wills proved to be very popular, and by C99?, =:I of !mericans had completed a living will.GC:H In response to public needs, state legislatures soon passed laws in support of living wills in virtually every state in the union.GCCH 7owever, by the late :;@9s public advocacy groups became aware that many people remained unaware of advance directivesGCAH and even fewer actually completed them.GC=HGC8H In part, this was seen as a failure of health care providers and medical organi2ations to promote and support the use of these documents.GC<H 4he publicBs response was to press for further legislative support. 4he most recent result was the Patient Self- etermination

!ct of :;;9,GC?H which attempted to address this awareness problem by re-uiring health care institutions to better promote and support the use of advance directives.GCCHGC@H 7owever, as living wills began to be better recogni2ed, key deficits were soon discovered. 'ost living wills tended to be limited in scopeGC;H and often failed to fully address presenting problems and needs.GA9HGA:H .urther, many individuals wrote out their wishes in ways that might conflict with -uality medical practice.GACH Ultimately, it was determined that a living will alone might be insufficient to address many important health care decisions. 4his led to the development of what some have called Ksecond generationL advance directivesGC;H M the Khealth care pro"y appointmentL or Kmedical power of attorney.L /iving wills also reflect a moment in time, and may therefore need regular updating to ensure that the correct course of action can be chosen. 'angal >apoor has recently written an article for the 'ail )nline discussing his e"periences with his mother1s living will and his concerns GAAH )n Duly C@, C99;, &arack )bama became the first United States President to announce publicly that he had a living will and to encourage others to do the same. 7e told an !!6P town meeting, ESo I actually think it1s a good idea to have a living will. I1d encourage everybody to get one. I have oneJ 'ichelle has one. !nd we hope we don1t have to use it for a long time, but I think it1s something that is sensible.EGA=H 4he announcement followed controversy surrounding proposed health care legislation that included language that would permit the payment of doctors under 'edicare to counsel patients regarding living wills, sometimes referred to as the EinfamousE page =C8.GA8H Shortly afterwards, liberal bioethicist Dacob !ppel issued a call to make living wills mandatory.GA<H

Durable power o$ attorney and health care pro.y

2ain articles: 3ealth care proxy and /ower of attorney
Secon# $eneration %#vance &irectives
!s before, the ne"t generation advance directive was drawn from e"isting law M specifically from business law. Power of attorney statutes have e"isted in the United States since the days of Kcommon lawL %i.e., laws brought from ,ngland to the United States during the colonial period+.GA?H 4hese early powers of attorney allowed an individual to name someone to act in their stead. rawing upon these laws, Kdurable powers of attorney for health careL and Khealth care pro"y appointmentL documents were created and codified in law, allowing an individual to appoint someone to make health care decisions in their behalf if they should ever be rendered incapable of making their wishes known.GA@H 4he appointed health care pro"y has, in essence, the same rights to re-uest or refuse treatment that the individual would have if still capable of making and communicating health care decisions.GA;H

4he primary benefit of second-generation advance directives is that the appointed representative can make real-time decisions in actual circumstances, as opposed to advance decisions framed in hypothetical situations, as recorded in a living will. 4his new advance directive was heartily endorsed by the !merican public, and supporting legislation soon followed in virtually all states.GA;H ,ventually, however, deficiencies in Ksecond-generationL advance directives were also soon noted. Primarily, individuals faced problems similar to those that handicapped living wills M- knowing what to tell the pro"y decision-maker about oneBs wishes in a meaningful way. Studies found most of what appointed pro"ies are told is too vague for meaningful interpretation.G=9HG=:HG=CHG=AHG==H In the absence of meaningful information, family and physician KguessworkL is found to be inaccurate as much as ?<I of the time.G=8HG=<HG=?H G=@HG=;HG89HG8:HG8CH 4his continuing problem led to the development of what might be called Kthird generationL advance directives.

Thir# $eneration %#vance &irectives

4hird generation advance directives were designed to contain enriched content to assist individuals and their appointed agents, families, and physicians to better understand and honor their wishes. 4he first of the third-generation advance directives was the Nalues 7istory by oukas and 'c$ullough, created at the Feorgetown University School of 'edicine, first published in :;@@, and then more widely cited in an article in :;;:.G8AHG8=H 4he Nalues 7istory is a Ktwo-part advance directive instrument that elicits patient values about terminal medical care and therapy-specific directives.L 4he goal of this advance directive is to move away from a focus on specific treatments and medical procedures to a focus on patient values and personal goals. !nother values-based pro3ect was later published by /ambert, Fibson, and (athanson at the Institute of Public /aw, University of (ew 'e"ico School of /aw in :;;9.G88HG8<H It continues to be made available via the 7ospice and Palliative $are .ederation.G8?H )ne persistent challenge of third generationbased values documents is to show a linkage between the elicited values and goals with medical care wishes, although studies have demonstrated that values regarding financial and psychological burden are strong motivators in not wanting a broad array of end-oflife therapies.G8@H 4he ne"t widely recogni2ed third generation advance directive is the 'edical irective, G8;HG<9H created by ,manuel and ,manuel of 'assachusetts Feneral 7ospital and 7arvard 'edical School. !lso still available,G<:H it is a si"-page document that provides si" case scenarios for advance medical decision-making. 4he scenarios are each associated with a roster of commonly considered medical procedures and interventions, allowing the individual to decide in advance which treatments are wanted or not wanted under the circumstances. Several criticisms regarding this advance directive have been e"pressed. G<9HG<CHG<AH Primarily, it prompts individuals to make medical treatment decisions, which they are typically not e-uipped to make.G<CH Perhaps the best known third generation advance directive is the .ive 0ishes directive.G<=H 4his document was developed in collaboration with multiple e"perts with funding from

the 6obert 0ood Dohnson foundation,G<8H and is distributed by the organi2ation !ging with ignity. 4he document was endorsed by 'other 4eresa of the Sisters of $alcutta and by the $hief Dustice of the .lorida state supreme court.Gcitation neededH 4he document meets statutory criteria in =C states.G<=H 4he most recent 4hird-Feneration advance directive is the /ifecare !dvance irective.G<<H G<?H In creating this document, researchers reviewed more than <,899 articles from medical, legal, sociological, and theological sources. 4he conclusion was that advance directives needed to be based more on Ehealth outcome statesE than on rosters of medical treatments and legal 3argon. &uilding upon the insights gleaned from the literature review, an advance directive document created, tested in a study involving nearly :,999 participants, and then comparison tested against other popular advance directive forms. 4he results indicated greater patient#pro"y decision-making accuracy, and superior comprehensive content as compared with other documents tested.G<@H 4he primary criticism has been that it is very lengthy and tedious to complete. 0hile some commentators suggest that any recording of oneBs wishes is problematic,G<CH G<;H the preponderance of e"perts recommend the completion of an advance directive document M especially one that includes both a living will and a pro"y designation.G?9HG?:H 0hile most of the public continue to rely upon their stateBs standard directive format, research demonstrates that many of these documents are too 3argon laden and vague,G<AHG?CH G?AHG?=H confusing,G?8HG?<HG??HG?@HG?;H and incomplete to ade-uately capture an individualBs wishes, and that they focus too much on the needs of medical and legal practitioners to the e"clusion of the needs of patients.G@9HG@:HG@CH !dvance directive documents are increasingly available online.G@AH Some legal commentators have suggested that using a non-statutory advance directive will leave the user with a document that may not be honored. 7owever, legal counsel for the 7astings $enter for &ioethicsG@=H refute this assertion.G@8H 4o make the best choice, individuals should consider reviewing several document styles to ensure that they complete the document that best meets their personal needs.

Legal situation by country

(ote5 Some of the countries listed below are not in common law 3urisdictions in variance to the scope of this 0ikipedia page. 'any of them are in the ,uropean Union, where civil law predominates. 4his recent paper summari2es advance health care legislation in the ,uropean Union. G@<H

%ustralia
4he concept of an !dvance 7ealth irective is defined in the Powers of attorney act of 1998 and Guardianship and Administration act of 2000. G@?H

The 'etherlan#s
In the (etherlands, patients and potential patients can specify the circumstances under which they would want euthanasia for themselves. 4hey do this by providing a written euthanasia directive. 4his helps establish the previously e"pressed wish of the patient even if the patient is no longer able to communicate. 7owever, it is only one of the factors that is taken into account. !part from the will in writing of the patients, at least two physicians, the second being totally unrelated to the first physician in a professional matter %e.g. working in another hospital, no prior knowledge of the medical case at hand+, have to agree that the patient is terminally ill and that no hope for recovery e"ists.Gcitation
neededH

$er(any
)n :@ Dune C99; the &undestag passed a law on advance directives, applicable since : September C99;. Such law, based on the principle of the right of self-determination, provides for the assistance of a fiduciary and of the physician.

)taly
Italy currently lacks living will legislation, though there are laws that allow patients to refuse life-sustaining medical treatment.G@@HG@;HG;9H $ontroversy over end-of-life care emerged in Italy in C99<, when a terminally ill patient suffering from muscular dystrophy, Piergiorgio 0elby, petitioned the courts for removal of his respirator. ebated in Parliament, no decision was reached. ! doctor eventually honored 0elby1s wishes by removing the respirator under sedation.G;:H 4he physician was initially charged for violating Italy1s laws against euthanasia, but was later cleared. .urther debate ensued after the father of a A@ year-old woman, ,luana ,nglaro, petitioned the courts for permission to withdraw feeding tubes to allow her to die. ,nglaro had been in a coma for :? years, following a car accident. !fter petitioning the courts for :9 years, authori2ation was granted and ,nglaro died in .ebruary C99;.G;CH In 'ay C99@, apparently as a result of the recent $ourt of $assationBs holding in the case of ,nglaro, a guardianship 3udge in 'odena, Italy used relatively new legislationG;AH to work around the lack of the advance directive legislation. 4he new law permitted a 3udicially appointed guardian %Kamministratore di sostegnoL+ to make decisions for an individual. .aced with a ?9-year old woman with end-stage /ou FehrigBs isease who was petitioning the court %with the support of her family+ to prevent any later use of a respirator, the 3udge appointed her husband as guardian with the specific duty to refuse any tracheotomy and#or respirator use if#when the patient became unable to refuse such treatment herself.G;=H

S*it+erlan#
In Swit2erland, there are several organi2ations which take care of registering patient decrees, forms which are signed by the patients declaring that in case of permanent loss of 3udgement %e.g., inability to communicate or severe brain damage+ all means of prolonging life shall be stopped. .amily members and these organi2ations also keep

pro"ies which entitle their holder to enforce such patient decrees. ,stablishing such decrees is relatively uncomplicated. 7owever, in Swit2erland, a patient decree has, as of (ovember C99@, no legally binding effects, whether concerning civil or criminal aspects. Such a decree is today merely viewed as representing the supposed will of the person with the incapability. 4here is, however, a revision of the Swiss $ivil $ode under way that aims to change this situation %intended to be article A<9 of the Swiss $ivil $ode+ by making the patient decree a legally binding document.G;8HGcitation neededH

,nglan# - Wales
In ,ngland and 0ales, people may make an advance directive or appoint a pro"y under the 'ental $apacity !ct C998. 4his is only for an advance refusal of treatment for when the person lacks mental capacity and must be considered to be valid and applicable by the medical staff concerned.G;<H In Dune C9:9, the 0ealth 'anagement Solicitors, 'oore &latch, announced that research showed demand for /iving 0ills had trebled in the two years previous, indicating the rising level of people concerned about the way in which their terminal illness will be managed.G;?H !ccording to the &ritish Fovernment, every adult with mental capacity has the right to agree to or refuse medical treatment.G;@H In order to make their advance wishes clear, people can use a living will, which can include general statements about wishes, which are not legally binding, and specific refusals of treatment called Eadvance decisionsE or Eadvance directivesE.G;;H

.nite# States
In the United States, most states recogni2e living wills or the designation of a health care pro"y.G:99H .or e"ample $alifornia does not recogni2e a living will but instead uses an !dvance 7ealth $are irective.G:9:H 7owever, a Ereport cardE issued by the 6obert 0ood Dohnson .oundation in C99C concluded that only seven states deserved an E!E for meeting the standards of the model Uniform 6ights of the 4erminally Ill !ct.G:9CH Surveys show that one-third of !mericans say they1ve had to make decisions about end-of-life care for a loved one.G:9AH In Pennsylvania on (ov. A9, C99<, Fovernor ,dward 6endell signed into law !ct :<;, which provides a comprehensive statutory framework governing advance health care directives and health care decision-making for incompetent patients.G:9=H !s a result, health care organi2ations make available a E$ombined /iving 0ill O 7ealth $are Power of !ttorney ,"ample .orm from Pennsylvania !ct :<; of C99<.E Several states offer living will EregistriesE where citi2ens can file their living will so that they are more easily and readily accessible by doctors and other health care providers. 7owever, in recent years some of these registries, such as the one run by the 0ashington State epartment of 7ealth, have been shuttered by the state government because of low enrollment, lack of funds, or both.G:98H