Advanced Directives/Living Wills

[Hairyman]

As an offshoot of the eugenics thread (http://forums.zgeek.com/showthread.php?t=39141) I would like to start a debate about the value of advanced directives/living wills.

These have become more popular as medical science has advanced and people are aware that there are outcomes from certain treatments that they would not want.

Some of the difficulty with writing a living will is being suitably specific about what one is trying to acheive/avoid.

There are common instances where such things are ignored after discussions with the temporarily incompetent patients' person responsible (NSW legislation) or legal guardian/next-of-kin (elsewhere).

In the absence of a discoverable person responsible, then medical staff face somewhat of a quandary. Do you accept the directive at face value which may lead to an outcome that is exactly the opposite of the spirit of the directive? Do you ignore the directive and face the risk of someone waking up and persuing legal action for an outcome unacceptable to them? Do these living wills have much legal weight at all?

In addition, many people change their minds about what is an acceptable quality of life as time goes past. So for some chronic diseases certain people never reach the point of finding it all to miserable to continue treatment (I want to leave euthanasia aside in this thread). For some people with acutely disabling conditions (spinal cord injury for example) find that life is still pretty worthwhile even thought if you had asked them the day before their injury what they would have wanted if they were paralysed is to be left to die. This makes it even more difficult for the proxy decision maker or the person compiling a living will.

I have several other thoughts, but do not wish to pollute the debate with them at this stage.

So....

Are they just a crock of shit that gets in the way of good medical management?

Are they an important expression of preferences by an autonomous competent person that is essential to protect one from the interventions of over-aggressive doctors with god-complexes?

Are they worth the paper they are written on if push comes to shove?

How can you write one to ensure that you get what you want?

[Marshall77]

Very good question.

I don’t think medical people should be held responsible for treating some and the outcome not being what they wanted. Medicos are supposed to whatever they can to preserve life.

I also think that if the Living will is well written and in no way ambiguous it has to be treated as a legal document. You cannot do something to an individual without consent and a living will put the persons wishes in writing for a time when they might not be able to speak for themselves.

As for writing one you might need to talk to some people in both the legal and medical disciplines. Also you should probably jot done key points to talk about with these people. ie you don’t want to be kept alive and machines if you have serious brain injury/don't resuscitate/cancer at want point you want treatment stopped and to be unplugged and returned home to be with your family/dementia. etc.

Anyhow thats my 2 cents