I was asked this question by D.F., of Van Nuys, CA.:

Can I assure my wishes will be followed, about termination of medical treatment, if there is no way of saving me?

Dear D.F.:

Yes; in the unfortunate situation you have discussed we now have two documents to set forth your wishes, the "Living Will" and the "Health Care Proxy". Although either instrument standing alone might be sufficient, in my practice I generally recommend both instruments be executed.

The Living Will expresses the desire to "pull the plug" (terminate treatment if there is no hope of saving you), and the Health Care Proxy appoints an agent who may express and make health care decisions on your behalf, when you are not about to die but are unable to make medical decisions for yourself.

Both documents are relative newcomers on the medical scene. With our population aging, and the medical advancements in keeping people alive, questions about the quality, as opposed to the quantity, of life have become sharply focused. In response, most States have enacted laws allowing the use of such documents. So now, when you enter a hospital, it usually has them available, if you desire their use. In this article, I will discuss the Living Will.

Please note, the Living Will's language usually speaks of prolonging dying. It often states: "If I (the patient) should be in an incurable or irreversible mental or physical condition with no reasonable expectation of recovery, I direct my attending physician to withhold and withdraw treatment that serves only to prolong my dying. These directions shall apply if (a) I am in a terminal condition, (b) I am permanently uncon-scious, or (c) I am conscious but have irreversible brain damage and will never regain the ability to make decisions and express my wishes." Recognize that these conditions are extreme.

It is only after your caregiver (doctor) determines these conditions are present that your wishes, as set forth in the Living Will, take on critical importance. Remember, this document simply expresses your wishes and if the caregiver has any reservations or uncertainty, they may (should?) refuse to assist in carrying them out. There are theological questions here, and they are outside the scope of this article.

The procedures and treatment that may be withheld and withdrawn include, without limitation, surgery, antibiotics, cardiac and pul-monary resuscitation (CPR), respiratory support, and artificially admin-istered feeding and fluids. Direction may be given that treatment be limited to measures to keep you comfortable and to relieve pain, even if such measures shorten your life.

Another provision often requested is to live out your last days of life at home rather than in a hospital, if it does not jeopardize your chance of recovery to a meaningful and conscious life and does not impose an undue burden on your family.

The Living Will clearly takes effect in extreme circumstances. Even then, it does not function in a vacuum. There are several levels of review, including the caregivers', and all would hope that your best interests are foremost in the minds of those involved.

Although the Living Will is not for protection of property, its use is advocated for proper planning. It's just one of the documents included when I prepare your Living Trust. Generally, the others are the Pour-Over Last Will, the Health Care Proxy and the Durable Power of Attorney.