Living Will May Not Solve End-of-Live Issues
By Betty Gibb, Kansas Senior Press Service
A project of the KU Center on Aging
Q. What is the surest way of guaranteeing that I’ll not be kept alive by some machine or feeding tube long after any real life is gone? I’ve got a living will, but will that be enough?
A. Living wills are in the news this month partly because of an article published in the bioethics journal, the Hastings Center Report. A University of Michigan researcher found that living wills often do not fulfill their purpose. The article certainly doesn’t recommend doing away with the living will or for a person to choose not to fill one out—it just suggests that more is needed.
The authors presented five tests that living wills would need to meet to really work—and they failed all five. Here they are:
- Most people would need to have a living will so it would become the standard rather than the exception—they don’t.
- A person would have to know for sure what they want in some hypothetical future. “People have trouble predicting what groceries they’re going to buy next week, says co-author Carl Schneider, a University of Michigan Law School and Medical School professor. So it stands to reason they would have trouble predicting exactly what they will want in a circumstance they have never experienced and can’t foretell.
- People would need to be able to state their wishes accurately and understandably—and more often than not, they can’t.
- The document would need to be available when the decision needs to be made—and often that is not the case.
- Surrogate decision makers need to be able to reliably apply the instructions of the living will to the patient’s current health condition.
“The complexities of modern medical care and the very fluid nature of the process of dying, in which patients can be skirting death one minute and relatively safe the next—makes it nearly impossible for a technical document to capture all the possibilities,” says William D. Smucker, MD, author of a study reported in the Archives of Internal Medicine.
So, if not a living will, what? The experts advise making out a living will—but also getting a durable power of attorney for health care. This document allows you to name someone whom you trust and would want to make decisions about your care. That person is often a family member—spouse or child—but doesn’t have to be.
Durable powers of attorney for health care only require a few simple choices, and they don’t different much from the existing system of allowing the next-of-kin to make medical decisions about an incompetent patient. They also allow the decision-maker to use the information about the patient’s condition that’s available at the time a decision is needed, rather than asking the patient to guess about something far into the future.
Of course, decisions as important as a living will and a durable power of attorney for health care should be discussed with family members. It is also really important that your primary care physician have an understanding of your wishes—especially when the prospect of death becomes real or imminent because of a medical diagnosis.
You are certainly wise to begin researching your options for end-of-life decision making. The Kansas Department on Aging offers an excellent booklet that will help you with these and other decisions and the needed forms. The booklet, “Resource Guide for Seniors,” is available without charge. Go to the website: www.agingkansas.org and select publications. You can call 1-800-432-3535 to request the booklet, or visit your local Area Agency on Aging.
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