Living Will / Directives Personnelles Anticipées (definitions & recommendations)

A Living Will (also variously referred to in the U.S. as Advance Health Directives or simply Advance Directive) is a document that is designed to set forth your wishes concerning medical treatment if and when you are no longer able to communicate them yourself because of illness or injury.

It is a text composed by you, or can be a form filled out and signed by you, dated, etc. In France it is called a testament de vieor Déclaration de Directives Personnelles Anticipées (DPA).

In the same or a separate document you may mandate a person to take health care decisions for you if you are unable to make them yourself. This person is variously referred to in the U.S. as a “health care agent” (with) “Durable power of Attorney for Health Care” or “proxy for health care”. In France this person is referred to as the personne de confiance. Designating a personne de confiance may be required by some hospitals in France before surgery.

In any case, this agent for your health care decisions should have a copy of your living will and agree to be guided by its contents.

Forms: In the U.S. forms are available from hospitals, on the internet, and elsewhere. Different states have different forms that respond to local legislation that complements the federal laws. If you visit regularly in the U.S. you may want to check out the forms there to be sure your living will meets the requirements for the state(s) where you regularly sojourn.

In France, at present, there is no form available from hospitals as far as we can ascertain.

Certain hospitals will provide you with a document informing you of your rights as set forth in the Code de la Santé publique.

The Association pour le Droit de Mourir dans la Dignité (ADMD, 50 rue de Chabrol, Paris 75010 tel. 01 48 00 04 92 email admd@club-internet.fr ) provides forms to its members.

AAWE forms: E-mail the office to ask for the forms (aawe@orange.fr, or click Living Will Template for the .pdf format or click Living Will template for the Word document. Drafts en français incorporating elements from various forms used in the U.S., and by the A.D.M.D. in France and in Belgium, were drawn up for AAWE members prior to the meeting on the subject of Living Wills in January 2004. These forms have evolved somewhat over the last year, especially in view of the “laisser mourir” legislation recently passed by the Assemblée Nationale and the Senat and applied as of April 22, 2005.

But no “form” is necessary.

A freely written living will, (especially in your own handwriting – or so it would seem), is probably given more weight than a signed standard printed form. Make this document YOUR OWN. Be sure to weigh carefully your end of life choices. It is important that your wishes be very clear. For instance, be precise concerning your wish to refuse or allow cardiopulmonary resuscitation (CPR), artificial nutrition (tube) feeding and hydration, etc. The Health Directive of D.C., Maryland, Virginia (also on file at the AAWE office) has short, clear and precise definitions of the kinds of treatment that can be refused or accepted in certain conditions. You may wish to be more precise concerning medication or treatment for your particular condition, but you must remember that in France at this time, it is the doctor who finally decides. Whenever possible be sure your doctor is clear about, and in agreement with, your advance directives. If your doctor is not in agreement you may want to reconsider your choice. If we understand correctly, you or your agent can insist on changing doctors, on being moved to another service or hospital, or to hospice care.

Euthanasia is not a legal possibility in France. Yet it exists and is practiced. A clear statement of the will of the patient to be allowed to die as gently as possible can help guide the doctors who will make the decisions.

At the January 14, 2004 AAWE Seniors’ meeting on this subject, Adele Annis of the American Aid Society insisted on the importance of your doctor’s role. She suggested that you ask him to write a statement concerning your condition and what treatments you refuse. For a hospital and unknown doctors this statement may be of more influence than your Directives Anticipées document. In case of an emergency, and if possible, Adele advised us to avoid calling the SAMU or the pompiers who will take you to the nearest hospital where treatment may be started which you wish to refuse. Call or have the doctor call a private ambulance service and instruct them to take you to the hospital of your choice, preferably where your doctor is known and can have you admitted. In Adele’s words: “The key is: 1) the ambulance, 2) the hospital, 3) the doctor.”

We recommend that every adult, no matter what your age or health, draw up these documents. A terrible accident or illness can suddenly make them very important.

Make these documents your very own. If you compose your living will from scratch you will be forced to ask yourself all the hard questions and write out your own answers to them.

This is very hard to do. It is hard to do at any time in your life; but it is certainly easier now than later.

All questions and options should be thoroughly discussed with those closest to you as well as with your regular doctor médecin traitant. All family members should have copies, or should know about your living will and its contents. They should all know who is named as your agent for health care decisions. Any members of your family who are opposed to the decisions you have taken should be named and excluded from making decisions concerning your care.

Remember that you may change or cancel these documents at any time. The law specifies that documents should be dated within the last three years. Remember to update them as necessary.

Keep your living will (directives anticipées) and your power of attorney for health care agent (mandat pour la personne de confiance) in an easily accessible place, known to your immediate family.

Copies should be given to:

1. your health care agent (your personne de confiance),

2. all members of your family,

3. your médecin traitant, who is responsible for adding it to your medical file,

4. the director of your retirement or nursing home,

5. and included in your file, if hospitalized.

– Olive Lorsignol and Seniors of AAWE