Living Will and Cancer Care

A living will is a written record of the treatments you would want, and the ones you would refuse, if you became too ill to speak for yourself. The National Institute on Aging describes it as a place to say "which common medical treatments or care you would want, which ones you would want to avoid, and under which conditions each of your choices applies."

That last phrase is the useful part. A living will is not a single yes-or-no vote on aggressive care. It lets you attach your answer to a situation. Many people with cancer want full intensive care during a planned high-risk treatment, and want a different approach if the cancer stops responding to every available drug. Both wishes can sit in the same document.

This page is educational, not legal advice. Forms and signing rules are set by each state. A hospital social worker, a patient advocate, or a legal aid office can check your paperwork against the rules where you live.

Advance directive forms tend to walk through the same short list of decisions.

• Cardiopulmonary resuscitation, or CPR. This means chest compressions, rescue breathing, electric shocks to restart the heart, and drugs. The National Institute on Aging notes it works less often in older adults who already have long-term illness.
• Mechanical ventilation. A breathing machine pushes air in through a tube placed in the windpipe. That placement is called intubation. It is uncomfortable enough that sedating medicine is usually needed.
• Artificial nutrition and hydration. This is food and fluid given through a vein or a feeding tube. The National Institute on Aging points out that studies have not shown it meaningfully extends life at the very end of life.
• Dialysis, which is a machine that filters the blood when the kidneys fail.
• Blood transfusions, tests, medicines, and surgery, listed by MedlinePlus as choices a living will can cover.
• Organ, tissue, and brain donation.

Write down the reasoning too, not only the checkbox. A note such as "I would accept a breathing machine for a short, reversible problem, but not as a long-term arrangement" tells your family far more than a tick in a box.

These are two different papers, and most people benefit from having both.

A living will speaks for you in writing. A durable power of attorney for health care names a person to speak for you out loud. The National Cancer Institute calls that person a health care proxy or medical power of attorney, and describes the document as one "that allows people to name another person to make decisions about their medical care if they are unable to make these decisions for themselves."

Cancer care throws up questions no form anticipated. A scan shows something new during a hospital stay. A clinical trial slot opens. A named proxy can weigh those choices against what you wrote. A form alone cannot.

Here is the point that surprises people most, and it is worth reading twice.

A living will is your statement of wishes. A do-not-resuscitate order, or DNR, is different. MedlinePlus is blunt about it: "A do-not-resuscitate order, or DNR order, is a medical order written by a health care provider." Nobody has to write that order simply because you own a living will.

That gap matters most at home. If an ambulance crew is called to a house, they act on medical orders they can see. MedlinePlus advises that your clinician "can tell you how to get a wallet card, bracelet, or other DNR documents to have at home or in non-hospital settings, so that emergency medical personnel will be able to understand your DNR status." Many states also use a portable medical order form, often called POLST or MOLST, signed by a clinician and kept in plain sight.

So if you want CPR withheld at home, a living will in a filing cabinet will not do it. Ask your oncology team directly for the order and the out-of-hospital paperwork that goes with it.

Also know what a DNR does not do. MedlinePlus states that it "is specific about CPR. It does not have instructions for other treatments, such as pain medicine, other medicines, or nutrition." A DNR does not cancel chemotherapy, antibiotics, transfusions, or comfort care. Nobody stops treating your pain because you signed one.

The National Cancer Institute warns that "each state has its own laws regarding advance directives" and that you should follow the laws of the state where you live or are being treated.

Cancer care makes that ordinary advice practical. People routinely travel across state lines to a specialist center for surgery, a transplant, or a trial. Take your documents with you, hand a copy to the medical records office at the second hospital, and ask whether that state needs its own form or witnesses.

Do this before a high-risk stretch of treatment, not during one. Stem cell transplant, major abdominal surgery, and treatments that can cause severe reactions are all easier to plan for while you are well enough to think clearly.

MedlinePlus advises giving copies to "your family members, providers, and health care agent," carrying a copy into hospital, and telling all medical staff involved in your care that the documents exist. Never leave the only copy in a safe deposit box or a locked file that nobody else can reach.

You can change your mind at any point. The National Cancer Institute is clear that even after signing, "you can change your mind at any time," and that outdated versions should be destroyed so no one acts on the wrong paper. Revisit the document when your cancer changes stage, when you switch to a new line of treatment, when your proxy moves away or becomes ill, and when your own view of what a good outcome looks like shifts.

Bring it up quickly if you are days away from a high-risk procedure, if you are moving care to another state, if your named proxy can no longer serve, or if a clinician has raised hospice or comfort-focused care. Ask outright whether an out-of-hospital order is needed for your situation. Getting an answer in writing costs one conversation and saves your family from guessing.

Related pages on this site cover Advance Directives During Cancer Care, Medical Power of Attorney, Financial Assistance for Cancer, and Cancer and Disability.

• https://www.cancer.gov/about-cancer/managing-care/advance-directives
• https://www.nia.nih.gov/health/advance-care-planning/preparing-living-will
• https://medlineplus.gov/ency/patientinstructions/000472.htm
• https://medlineplus.gov/ency/patientinstructions/000473.htm
• https://medlineplus.gov/advancedirectives.html
• https://www.cancer.gov/about-cancer/advanced-cancer/planning