Death

Death is defined as the ending of life or the total and permanent cessation of all vital functions of the body including the heartbeat, brain activity (including the brain stem), and breathing. Death can come in many forms. It can be expected, like the death occurring after diagnosis of terminal illness or unexpected like an accident. Death is also referred to as demise or decease.

A death certificate is an official document issued by a Government to the nearest relatives of a deceased stating the date, fact, and cause of death. A death certificate relieves the relatives of a deceased from social, legal, and official obligations of the deceased. It enables the settlement of property inheritance and authorizes the family to collect insurance and other benefits.

Living Wills and Advance Health Care Directives A Living Will and an Advance Health Care Directive (AHCD) are documents that allow a person to explain in writing which medical treatment he or she does or does not want during a terminal illness. A terminal illness is, of course, a fatal illness that leads ultimately to death. A Living Will takes effect only when the patient is incapacitated and can no longer express his or her wishes. The will states which medical treatments may be used and which may not be used allowing the patient to die naturally without the patient’s life being artificially prolonged by various medical procedures. Although the term “Living Will” sounds like a last will and testament, it is more like a Power of Attorney. The purpose of a living will is to allow you to make decisions about life support and direct others to implement your desires in that regard.

Living Wills are needed because advances in medicine now allow doctors to prolong and sustain life although the person will not recover from a persistent vegetative state. Some people would not desire to remain in that state while others would. Extending life when death is imminent to some people is only extending the suffering and prolonging of the dying process. The Living Will allows you to make the decision of whether life-prolonging medical or surgical procedures are to be continued, withheld, or withdrawn, as well as when artificial feeding and fluids are to be used or withheld. It allows you to express your wishes prior to being incapacitated. Your physicians or health care providers are directed by the Living Will to follow your instructions. You may revoke the Living Will prior to becoming incapacitated.

An AHCD is similar to a Living Will and specifies the care a person wishes to receive in case that they are unable to communicate their wishes, such as being in a coma. To be enforceable, the person making the directive must be of sound mind. In other words, the person must be able to think rationally and communicate his/her wishes in a clear manner. The document generally must be signed and acknowledged before a notary public in accordance with the laws in your state.

End-of-life decision making is governed by state law. All states now have legislation addressing end-of-life decision making and advanced health care directives. These statutes carry such names as the Death with Dignity Act, the Health Care Surrogate Act, the Health Care Decisions Act, and the Living Will Act.

A number of those statutes specifically address the issue of artificial nutrition and hydration. They generally provide that:

– The procedure is among those that may be withheld or withdrawn pursuant to the provisions of an advanced health care directive (AHCD);

– Artificial nutrition and hydration may be not be withdrawn, even if the patient is terminally ill or in a or

– The procedure may be withheld or withdrawn, but only if the person has an AHCD that meets certain statutory requirements and burdens of proof.

Some statutes provide that if a patient does not clearly indicate in an advance health care directive that nutrition and hydration are to be withheld or withdrawn, nutrition and hydration must be provided.

Ten FAQ on Living Wills and Advance Heath Directives

– What is a living will? A Living Will is a document that allows a person to explain in writing which medical treatment he or she does or does not want during a terminal illness. A terminal illness is a fatal illness that leads ultimately to death. A Living Will takes effect only when the patient is incapacitated and can no longer express his or her wishes. The will states which medical treatments may be used in certain situations, basically which may not be used in order to allow the patient to die naturally without the patient’s life being artificially prolonged by various medical procedures. The purpose of a living will is to allow you to make decisions about life support and direct others to implement your desires in that regard.

– I don’t want to be kept alive if I am in a “vegetative” condition or with irreversible brain damage. Can I use a living will to state my desires? Yes, but your state may have a different name for the instrument. End-of-life decision making is governed by state law. All states now have legislation addressing end-of-life decision making and advanced health care directives. These statutes carry such names as the Death with Dignity Act, the Health Care Surrogate Act, the Health Care Decisions Act, and the Living Will Act.

– What happens if there is no living will or durable power of attorney? If you have not planned ahead, the decision-making power passes to a family member or relative, sometimes a close friend, the attending doctor, or a court-appointed guardian. With medical technology advancing at such a fast pace, should you not have had your wishes made known to someone, someone will “step into your shoes” and make that decision during life-and-death situations when you are not competent to make the decision?

– What is an Advance Health Care Directive? Advance Health Care Directives are instructions pertaining to treatment preferences and health care given by individuals regarding what actions should be done or not done, in the event they are not able to make decisions due to illness or incapacity. It is a signed written document, giving or withholding consent in relation to medical or other professional care, treatment or service. Advance directives generally take the form of a living will, medical power of attorney and health care proxy.

– Who can be my agent to carry out these decisions? This is an important decision. You may have several close relatives or friends who would be willing to become your agent or attorney-in-fact for a Health Care Directive or Living Will. This person should be able to make tough decisions, to speak up in a crisis situation, to understand your values and desires and able and willing speak for you when you are unable to speak for yourself? Pick someone you trust, who will really listen to your feelings and values. Make sure that person is willing to assume the responsibility of being your representative.

– What does “lack of capacity” mean? It means you cannot understand the nature and consequences of the health care choices that are available to you, and, due to your physical condition you are unable to communicate your wishes to the world. On does not have to be declared non- compos mentis (not of sound mind) by a court in order to lack capacity to execute a living will or advance health care directive.

– What if I executed a Living Will in one state and then moved to another state? Your living will may not be honored in another state. Both a Power of Attorney for Health Care and Living Will are regulated by state laws, and there may be differences in requirements from state to state. This is somewhat of a gray area in the law. Therefore, it is best to have the same set of documents for your new state or at least have an attorney examine what you executed in your former state.

– What is life-sustaining procedure? A life-sustaining procedure is any mechanical or artificial means which sustains, restores or supplies a vital body function and which would only prolong the dying process for a terminal patient. A feeding tube and a mechanical respirator are examples.

– What is artificial nutrition and hydration? Artificial nutrition and hydration means invasive procedures such as tubes and intravenous feeding. It does not include the natural process of eating foods and drinking fluids.

– Can I revoke my Living Will? You can revoke your Living Will at any time prior to becoming incapacitated.