The Failure of the Living Will
A response to: Fagerlin, A. and Schneider, C. “Enough: The Failure of the Living Will.” Hastings Center Report 34(2): 30-42, March-April 2004
s are documents that attempt to ensure a patient’s health care wishes are known and respected. The Living Will was the first to become popularized and has long been the standard for advance directives.
The beneficial intention of completing a Living Will cannot be understated. Indeed, the form was created on foundation of wanting people to have a voice even when they cannot speak. The difficulty becomes that Living Wills often have unintended consequences including unnecessary cost, false sense of preparation, and arbitrary guidelines that do not best inform the reality of someone’s medical situation.
This article breaks down the reasons for the failure of the Living Will, including:
- The fact that living wills are often made without experience of what it is like to be ill.
- The difficulty on making concrete decisions regarding an unknown situation, illness, or circumstance.
- The time frames placed on withdrawal of life sustaining care.
“Not only do people regularly know too little when they sign a living will, but often (again, we’re human) they analyze their choices only superficially before placing them in the time capsule”
- Families with a strong knowledge of who a person is, are often legally and emotionally held captive to a time frame that has been generally arbitrarily chosen.
- Living Wills do not improve the ability of the surrogate decision maker to more accurately make decisions in line with their loved one’s wishes:
“Strikingly, surrogates who consulted the living will did no better than surrogates denied it.”
- What is the alternative?
“Patients anxious to control future medical decisions should be told about [medical] durable powers of attorney, which have many advantages over living wills. As these things go, they are simple, direct, modest, straightforward, and thrifty”.
The article concludes:
“In social policy as in medicine, plausible notions can turn out to be bad ideas. Bad ideas should be renounced. Bloodletting once seemed plausible, but when it demonstrably failed, the course of wisdom was to abandon it, not to insist on its virtues and to scrounge for alternative justifications for it. Living wills were praised and peddled before they were fully developed, much less studied. They have now failed repeated tests of practice. It is time to say, “enough.”
Living Wills need to be thoroughly examined and unintended consequences explored prior to assuming someone has prepared for their medical future. Should the result of a comprehensive review be that the Living Will does not address the variety of issues that can occur, that Living Will should be made invalid.
There are few things that can make the dying and death of a loved one even more difficult. Sadly, a Living Will can be one of those. A much more appropriate approach to advanced medical planning is to appoint a with whom you have had thoughtful exploration regarding the limits to the circumstances that you would want all efforts at life-sustaining care.
Advance directives are the plans you make for future health care in the event you become unable to make these decisions yourself. these plans can be verbal but are usually in writing. it is easier to communicate these plans if you put them in writing.
The medical durable power of attorney (MDPOA) allows people who become unable to make their own decisions to exercise their beliefs and wishes regarding medical procedures. The person's agent can communicate on behalf of the sick or injured person, preventing unwanted treatment.
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