When you create your living will, you’ll probably see a question that asks you to provide general guidance for your healthcare agent, choosing among the following options:
- Receive care only if it will improve my condition
- Receive care if expected benefits outweigh the expected burdens
- Receive care in all cases
Read on to learn what each of these options mean so that you can decide which is best for you.
Difference at a glance
As a first pass, you can think of these three different options on a continuum from least amount of medical intervention to most amount of medical intervention.
That continuum would look like this on a least -- > most basis:
Receive care only if it will improve my condition -- > receive care if expected burdens outweigh the expected benefits --- > receive care in all cases
Let’s look at each option more closely.
Receive care only if it will improve my condition
Select “receive care only if it will improve my condition” if you want your healthcare agent to authorize care only if that care is expected to improve or resolve your underlying health issue.
For example, if you are diagnosed with a serious disease with low success rates of available treatments, the healthcare agent may decide against pursuing aggressive treatments that are unlikely to result in a substantial improvement and instead focus on palliative care measures.
Receive care if expected benefits outweigh the expected burdens
By selecting “receive care if expected benefits outweigh the expected burdens,” you instruct your agent to pursue treatment if he or she believes, after discussions with your medical team and careful review of the circumstances, that the likely benefits from the treatment merit the potential adverse effects or discomfort (if any) in pursuing it.
Receive care in all cases
Providing guidance to “receive care in all cases” is the most straightforward. You should select this option if you want to continue to pursue all possible medical interventions to maintain or prolong life regardless of the underlying circumstances or potential outcomes.
Difference between receive care if expected benefits outweigh the burdens and receive care only if it will improve my condition
You might be confused by the difference between “receive care if expected benefits outweigh the burdens” and “receive care only if it will improve my condition” as they both sound fairly similar.
To understand this difference better, imagine a person who has been diagnosed with advanced-stage cancer that has spread throughout their body. The person's prognosis is very poor, and the available treatment options have low success rates with significant side effects.
As long as the expected benefits outweigh the expected burdens, a healthcare agent operating under that guidance should advocate to pursue the treatment. Despite the limited chances of a complete cure, the treatment may be judged to provide some relief, comfort, or extended life expectancy that outweighs the burdens.
On the other hand, an agent operating under the guidance to pursue care only if it will improve the patient's condition might decide to forgo the treatment. Given the advanced stage of the cancer and the low success rates of available treatments, the healthcare agent might decide against pursuing aggressive treatments that are unlikely to result in a substantial improvement. Instead, the agent might focus on palliative care measures to enhance the person's comfort and quality of life during their remaining time.
The Final Word
Choosing which type of general guidance to provide your healthcare agent is just one of the different choices that you have in a living will or advance health care directive, and you can always write in your own custom instructions if you feel they better capture your preferences.
At the end of the day, remember that making healthcare decisions based on general guidance will never be totally black and white. That's why the most important decision that you can make in your advance healthcare directive is designating a healthcare agent who knows you and your values well.
