Wednesday, February 15, 2012

The dangers of a 'living will'

I'm sure many readers have had the same experience as I. You go to see your physician for a routine checkup or some minor complaint, or you go into hospital for a simple procedure, only to be asked by one of the assistants whether you've made a 'living will' or so-called 'advance health care directive'. This is supposed to convey your wishes to medical personnel in the event that you are so severely injured, or so incapacitated by serious illness, that you're no longer able to do so. In particular, the 'living will' is supposed to guide medical personnel in any decision to continue or cease treatment, if your condition is so severe that recovery is considered extremely unlikely or impossible.

Unfortunately, the wording of such 'living wills' can hamstring your loved ones in the event of a medical emergency, in ways you might not have anticipated. This is partly because the 'legalese' in which they're written is complex and not always easily understood, and partly because, once they're signed, they may supersede the wishes of other family members. Blogger Pascal Fervor points out the difficulties.

I am not going to argue for or against living wills here. I am far more interested in bringing to public attention something I find unconscionable to keep to myself. Please read this and return.

Quite simply, this form's wording would permit complete strangers to prevent life-saving measures from being provided to the signer of this document. It would legally overrule everyone who actually loves and has an interest in protecting the patient. Should a family member or family physician protest, it would not matter. The standard form legally takes away all authority from them.

Example: You are in a car accident and wind up in a coma.

Attending doctor: “I don't think she'll survive. Better to withhold oxygen.”

Attending doctor's colleague: “I concur.”

Attending doctor to your husband: “Sorry, but it's what we think. Now even though your wife never knew me or our emergency room, she agreed to abide [by] our opinion. Legally. Buh-bye.”

There's more at the link. Highly recommended reading for anyone who's considering signing a 'living will', or who's already done so. (In the latter case, if you want to change it, you'll have to write formally to the doctor[s] and/or hospital[s] concerned, probably by registered or certified mail, informing them that you're withdrawing the earlier version of the 'living will' and substituting a re-worded one that provides greater protection to you. I recommend you insist that they destroy all copies of the previous 'living will' and certify to you, in writing, that they've done so.)

I'd like to add that in one particularly tragic case with which I was involved as a pastor, a woman who'd completed just such a 'living will' was involved in a car accident. The physicians at the hospital where she was taken for treatment declared her to be too severely injured to recover, and they proceeded to turn off life support even before her husband arrived. (He had to travel from another state.) Informed by telephone, he protested, and demanded time to arrange a second opinion. However, they refused to wait long enough for him to bring in another specialist. By the time he arrived and could make the necessary arrangements, life support had been switched off for several hours. His wife was already so brain-damaged as to be beyond help.

He called in another specialist anyway, who later informed him that he thought it likely his wife's condition might not have been so terminal as the original doctors inferred. However, her condition had deteriorated so much after removal of life support that it was no longer possible to save her - and the deterioration had also rendered it impossible to say for sure whether she might have recovered in the first place. The doctors responsible covered themselves by pointing to her 'living will', which authorized the termination of life support under such conditions. An attempted lawsuit against them failed for that reason.

Please, folks, don't inflict that sort of agony on your family. Check this out carefully, read Pascal Fervor's blog post about it, and take steps to protect yourself and your loved ones from over-officious doctors!



Shane said...

I have been asked that very question several times in the last six months and will be asked again on Friday. Thank you for clearly and concisely articulating my concerns regarding such documents. It hasn't reached the point where such a document might have applied, but you never know what may happen next time, even with basic outpatient surgical procedures.

Jess said...

A advance directive is good, but a medical power of attorney adds steps to circumvent the hasty decisions of doctors in the event you can't make the decisions.

I'm glad you posted about this subject. After a TIA, I realized my mother's legal directives were outdated and insufficient. I was responsible for her care, but had no legal means to protect her from bureaucrats and doctors. I was lucky she recovered and was able to help her find a better attorney for the documents that reflected her wishes.

She may reach the point she can't make any decisions, but there's a chain of family members that will be consulted before any medical procedures are performed that hasten her death.

Anonymous said...

I read the blog post you linked to and his recommendation that the additional sentence be added the will, "and with unanimous consent of my children."

I'm a nurse and my father has been a physician for over 46 years and I can tell you that "unanimous consent" may very well plunge that entire family, immediate and extended, into years of exhausting care for a brain dead loved one because one of the members is unable to emotionally let go.

Certainly I would not recommend hasty moves by anyone to withhold lifesaving interventions but I would also not wish for one person to over rule the combination of clinical facts, physician recommendations, and wishes of their siblings who conclude that life sustaining measures should be discontinued.

I it a very difficult decision to be made and extremes can occure on both side of the matter.

perlhaqr said...

once they're signed, they may supersede the wishes of other family members.

Yes. That's the whole point. So that your family can't keep you strung out on life support for years just because they lack the ability to let go.

Anonymous said...

Anonymous 1:

Notice that Pascal wrote of A Solution, not The Solution.

"I advised my mother ..."

That may well apply to him and his siblings and his mother would also have to know it applies. For others it might be "two out of 3" or a simply majority.

Anyone reading up on this topic is likely to have the good sense to reason out that if they have one or more difficult children that maybe unanimous is not a good requirement.

What's important is that the reader knows about the complete loss of family say in the matter if the forms are signed as they come as they were designed by the Florida legislature, the state of Terri Schiavo.

Peter said...

Around a year ago the hospital admissions clerk asked me to sign a very detailed form about resuscitation and life support. It was very explicit about the consequences of providing or denying these services. Almost frightening to read.

By the way, the hospital was the animal hospital, and the patient was Dipsy the cat. He made a full recovery.

Bob@thenest said...

I have such a document and have had 6 major surgeries since 2002. Latest was 20 days in the hospital, and none of that was rehab. In every case the hospital wanted to know if I had one and if I did they wanted a copy. NO WAY.

They will get it if and when my family decides to make it available, and each has a copy. And they were all present when I fully explained what my intentions were, just in case they should find it more suitable to shred it and go with my wishes as I explained them. So, so good! :-)

Pascal said...

Peter. Do you think an update might be suitable?

Hey I think we've found our kidney donor. She's got a living will.
Re standard living wills clause we warned about: "if my attending or treating physician and another consulting physician [whom I've never met] have determined that there is no reasonable medical probability of my recovery from such condition, I direct that life-prolonging procedures be withheld or withdrawn."

The money wasn't so much of a consideration when I first made that warning. I was more concerned about pessimistic triage and concerns about suffering. The corrupting lure of blood money appears now to be the one much bigger issue.