A living will and a last and testament are not the same thing – it is also not the same as a general power of attorney. Find out why the difference actually matters more than you think.
Store copies of your living will physically and digitally, carry a note in your wallet with your spokesperson’s contact, and make sure your doctor knows it exists. In an emergency, accessibility is everything.
Many of us fully intend to sign a living will, but it rarely feels urgent – until a medical emergency lands close to home, and you are confronted with decisions no family ever wants to make.
While a living will is not a financial instrument, it can have very real financial consequences: prolonged, invasive treatment in circumstances where there is no prospect of recovery can escalate costs rapidly, and those costs often land – emotionally and practically – on the shoulders of the people you love most.
What a living will actually is
A living will (often called an “advance directive”) is a standalone document intended to guide your medical practitioner and loved ones regarding end-of-life medical care if you are no longer able to communicate or express your wishes.
It is completely different from your last will and testament: a will deals with the distribution of your estate after death, whereas a living will deals with medical treatment while you are still alive but unable to make decisions or speak for yourself.
It is also not the same as a general power of attorney. In most cases, a power of attorney falls away when the person granting it loses mental capacity. A living will, by contrast, is designed for precisely that moment – when you can no longer give informed instructions.
What it can (and cannot) do
In practical terms, a living will is most often used to record your wish to die a natural death without being kept artificially alive by burdensome or invasive medical treatment, including (but not limited to) ventilation, dialysis, artificial feeding, medication, or life support, where there is no reasonable prospect of recovery and where, without medical intervention, death would be inevitable.
It can also be used to express your wishes regarding organ and tissue donation.
It is important to be clear about what a living will is not. Importantly, it is not a request for assisted suicide or euthanasia. A living will does not ask a doctor to end your life; it asks that you not be kept alive artificially in circumstances where recovery is not possible and where continuing treatment serves only to delay an inevitable death.
Ethical guidance in South Africa draws a clear distinction between allowing a natural death through withholding or withdrawing treatment, and any act where the primary intention is to end a patient’s life.
The legal enforceability of a living will
This is still the part that makes people hesitate: South Africa does not yet have a specific law that makes living wills formally enforceable in the way a contract would be enforceable, which means their legal status remains uncertain, even though they are widely used in practice.
How to strengthen the credibility of your living will
Because a living will is rooted in informed consent, the credibility of the document matters. Anyone over the age of medical consent and of sound mind can draft one, and ideally it should be signed in the presence of two independent witnesses – neither of whom are family members, beneficiaries, or part of your treating medical team.
This is not about red tape; it is about reducing doubt when emotions are high and decisions are time-sensitive.
Your wording should be clear enough to guide doctors in real-world decisions, and your wishes should align with the reality that emergencies are messy: a living will works best when it provides direction, not when it reads like a legal argument.
In addition, it should also be reviewed periodically, particularly after any major health event or life change that may shift your views.
The role of a medical proxy
It is also possible (and often advisable) to nominate a trusted spokesperson to communicate with doctors and your loved ones if you are unable to do so.
Consider appointing an alternate as well, in case your first choice is unavailable or emotionally unable to fulfil the role. The proxy’s job is not to improvise new decisions under pressure, but to help ensure that your wishes are understood, applied to the medical facts, and communicated clearly when fear and grief can cloud judgment.
Why a living will is a gift to your family
One of the main benefits of a living will is peace of mind: the comfort of knowing that your choices regarding end-of-life medical care are recorded and available when it matters most.
Many people fear dying less than they fear prolonged suffering, invasive interventions, or being kept alive indefinitely in a permanent vegetative state with no hope of recovery.
A living will helps you put boundaries around those fears in a way that is compassionate, practical, and clear.
A further benefit is the relief it can offer your loved ones. Without guidance, families are often left to make decisions without insight into what you would have wanted – at a time when emotions are raw, and tensions are high.
When people disagree, the conflict is rarely about medicine; it is about guilt, hope, grief, and the fear of “getting it wrong”. A living will can reduce the risk of painful arguments by giving your family a reference point when they are least equipped to navigate uncertainty.
There is also an unavoidable financial reality. Keeping someone artificially and indefinitely alive where there is no hope of recovery can place an enormous financial burden on the people left behind.
However, when affordability becomes the deciding factor, the emotional fallout can be devastating. While a living will cannot remove grief, it can help prevent a medical crisis from becoming a prolonged financial and moral ordeal.
Make it usable: tell the right people, store it properly
Importantly, a living will is only helpful if it can be produced when it is needed. If you decide to draft one, let your doctor know in advance and ensure that the people closest to you know it exists and where it is kept.
In an emergency, doctors have to act quickly and decisively, and they will want to know whether there is a living will and who your nominated spokesperson is.
Keep copies where they can be accessed easily – both physically and digitally – and consider carrying a simple note in your wallet or on your phone indicating that you have a living will and who to contact.
The absence of a living will can burden your loved ones with unthinkable decisions and potential financial hardship. If you feel strongly about how you want to be treated at the end of life, put it in writing – so that, when the moment comes, the people you love are guided by your voice, not forced to guess.
Article by Alex Odendaal – Crue Invest (Pty) Ltd