Do you have a living will? What does it say?

Specialties MICU

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Hello folks. I'm a new grad about to start working in NICU. However, the reason that I'm here today is that I'm starting to think about making a living will for myself, and I thought that ICU nurses would have a lot of insight.

Right now, my general sense is that I would want to be resuscitated during an acute crisis, but I don't want something like long-term ventilation if I'm not conscious or expected to recover.

However, I'm not informed enough about adult critical care to know exactly what treatment options I should say yes or no to in order to make my living will a useful document. Also, I'd like to hear ICU nurses' opinions on what interventions they would or would not want to have for themselves.

Thanks, Rhymeswithlibrarian

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Specializes in Family.

I actually have one printed (advanced directive and HCPOA) but I haven't had it notarized yet. Basically mine designates a poa and an alternate, and has a place to check to prolong or not to prolong life. It also states that tx for pain or discomfort should be provided at all times even if it hastens death. My plan is to type a different document for my dh and alternate that outlines what I want done exactly, ie if anoxic brain injury, no prolonging. I paid $13 for a package that allows me to do that paperwork as well as estate planning etc.

For me, I want to be on the vent as long as I have signs of life. If there is absolutely no hope for recovery after a 3-5 day period, I would want extubation. Now, if it were anoxic brain, I wouldn't want it to go that long.

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Mine is very, very specific.

I have to be declared brain dead by a minimum of 2 doctors (both must be Neurologists and not work for the same practice) for a period of four weeks before the plug can be pulled.

I also have a directive that if I am going to be left a Quadroplegic or have a major, physical disfigurement that covers more than 50% of my body, or the loss of 2 limbs or more, then a DNR should be in place and no life support.

I didn't have one for the longest time and I found out they can get as specific as you would like, and that made me very comfortable with my decision.

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Specializes in Surgical Intensive Care.

I do not have one, and should, but I have instructed my husband to listen to my sister (a nurse) and her husband (a nurse in med school) as well as my coworkers. I intend to make my sister my medical power of attorney as my husband has verbalized that he would never take me off the vent! I do not want to be kept alive- I have a great reward awaiting me- why prolong it?! I have made my wishes known to all, but to have it in writing is such a wonderful idea because when that time comes- it is so difficult to say enough is enough even if they know what you would have wanted...

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I just don't want to be trach'd

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Specializes in Nephrology, Cardiology, ER, ICU.

Having worked in the ER and now in dialysis, I realize that I do need an advanced directive. However...that said, I'm the worlds worst procrastinator and haven't done so.

In trauma's little world though:

1. Intubate, resuscitate and put me on life support for an acute even (ruptured AAA, AMI, acute MVA injury). However, if after a week to 10 days, I wasn't coming out of it with some semblence of normalcy, terminally wean me.

2. Don't stick me on dialysis if I am demented. Nothing worse than watching folks who are not even verbal be made to stay on dialysis.

3. Don't resuscitate me if I'm 90 years old! I have lived long enough.

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Thank you for your thoughts, everyone.

RWL

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Specializes in MICU.
Having worked in the ER and now in dialysis, I realize that I do need an advanced directive. However...that said, I'm the worlds worst procrastinator and haven't done so.

In trauma's little world though:

1. Intubate, resuscitate and put me on life support for an acute even (ruptured AAA, AMI, acute MVA injury). However, if after a week to 10 days, I wasn't coming out of it with some semblence of normalcy, terminally wean me.

2. Don't stick me on dialysis if I am demented. Nothing worse than watching folks who are not even verbal be made to stay on dialysis.

3. Don't resuscitate me if I'm 90 years old! I have lived long enough.

My thoughts exactly!!

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Specializes in ICU, now in Palliative Care Home Health.
Mine is very, very specific.

I have to be declared brain dead ... for a period of four weeks before the plug can be pulled.

4 Weeks? Can I ask why--we generally withdraw care ASAP after a determination of brain death.

And FYI, legal brain death must be declared by 2 independant docs anyways, no need to include that. However, I'm not sure if they need to be neurologists by law--my hospital uses neuros for it, but that may just be our policy.

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Specializes in ICU, Med/Surg, Ortho.
Mine is very, very specific.

I have to be declared brain dead by a minimum of 2 doctors (both must be Neurologists and not work for the same practice) for a period of four weeks before the plug can be pulled.

QUOTE]

You might want to check on that. In the state where I live (Arkansas), if you have been declared legally dead by two nerosurgeons the hospital has the right to pull the plug. I think there are several other states with that provision.

So, don't come here and get in a MVA and expect your living will to be followed here. Might want to not travel at all until you've done a little more research.

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YES! I'm just a new grad and haven't even passed my NCLEX yet, but after externing in the ICU for 3 months I filled out a living will. Mine was through an organization called NYLAG, which puts your living will in a database so that hospitals can access it easily if they need to.

Basically I said:

- i want everything curative if there is reasonable hope of recovering higher brain function.

- But if I was brain dead or a vegetable or in a coma and not expected to recover, I wouldn't mind withdrawal of care. i.e. I DONT want a full code, I don't want a new intubation, I'm okay with being put on morphine even if it hastens death, it's okay to take away my pressors, you can have my vital organs, you can take out my NG tube, but I want antibiotics (not sure of my reasoning there...it just seemed all right).

- If I'm in a coma with a very very slim chance of recovery but it's unlikely, I give permission to take me off life support & curative measures after 3 months. (This isn't a demand, it's just permission so my family won't feel guilty and won't rack up a huge indefinite bill).

The case that made up my mind was this elderly woman post mitral valve replacement who developed ischemic bowel that wasn't caught in time and was unconscious and had a lactate of >15 by the time my preceptor was assigned to her. The first thing my preceptor said to me when we entered the room was "she's dead already." And I was confused because we see a lot of unconscious patients in the ICU and she looked just about as unconscious as the next guy but not necessarily "more dead." But then again I'm very green and haven't seen too many dead people yet in my day. But the nurse just kept saying "she even LOOKS dead...she's going to crash today." The poor RN was super stressed with all the pumps and everything and the patient coded that afternoon and I'll never forget the sight of all the staff chaotic around her bed, doing CPR to this poor old woman's body until she was vomiting feces because she wasn't DNR. They got a spontaneous rhythm back but I remember thinking "so what? she's not going to get better." The only difference it made was that she had a rhythm for 3 more hours until she coded again and died. And that's why I have a living will. =/

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