What is a living will?

In certain situations, an existing advance directive can be highly relevant to medical decision-making in favor of palliative care. Most of the advance directive templates currently in use address the refusal of “artificial nutrition,” “artificial ventilation,” and “resuscitation” (limitation of treatment).

When drafting an advance directive, however, it is advisable to distinguish between limiting treatment and withdrawing treatment. People with ALS often receive care via a PEG tube, mask ventilation, or invasive ventilation. In this situation, it makes sense to establish criteria under which existing care should be discontinued (withdrawal of treatment).

As a result, sample advance directives have been developed that specify typical decision-making criteria for limiting treatment, as well as for potentially discontinuing treatment and initiating palliative care (available, for example, at www.als-charite.de).