Living Wills Should Be Put To Rest
There are few things harder than declaring failure. But, sadly, living wills are a failure.
The depressing spectacle of families such as the Quinlans, Brophys, Conroys and Cruzans stuck with no options but to keep their terminally ill and comatose loved ones alive by means of medical technology - because no one had ever asked if they would want to be kept alive - horrified the nation. Sensible people of good will tried to find a way to avoid entrapping people with medical technology they would not want.
The answer was the living will. By having people prepare written statements about their wishes and preferences before disease or disability left them unable to communicate, doctors and family members could have indisputable evidence to guide them if a tragedy struck.
The notion of advance directives seemed so obviously sound that pressure mounted throughout the last decade for state legislatures to grant them legal standing. Nearly ever state did. In 1990, Congress climbed on the fast-moving bandwagon by passing the Patient Self-Determination Act.
The law recognizes the importance of living wills and requires doctors, hospitals, HMOs and nursing homes to educate patients about them. The law also says that every patient must be given the opportunity to sign one.
Could any legal ducks ever be made to get in a straighter line? Living wills were obviously the answer. Easy, huh? Nope.
While organized medicine and the legal profession seem unable to acknowledge it, living wills are a bust. A burst of recent studies and surveys pound home the dimension of the failure.
More than three-fourths of all Americans do not have a living will. Most people do not even know much about them.
A new General Accounting Office report on the impact of the Patient Self-Determination Act says the impact of living wills on health care in America is “uncertain.” That is “bureaucrat speak” for “zip, nothing, nowhere.”
As the GAO report notes, even when a patient does have a living will, it is not clear that anyone - doctors or family members - pays attention to it.
Why don’t more people have living wills? Doctors, the GAO report notes, do not like to talk about dying and end-of-life care with their patients. One reason for their reluctance is that a lot of their patients do not want to talk about dying either. When the subject is dying, at least our own, most of us find other subjects more compelling.
A recent California study finds that many people, especially those who are Hispanic, American Indian or Asian, do not believe it is ethical to talk about their death. Many say it is arrogant to plan the manner of their deaths. Others say their families or religious leaders should decide their medical fates. Some say that to talk of death is to court it. Self-determination is not something every American values.
Living wills sometimes are ignored because they are not available when doctors need to see them. The few people who have them keep them in a safety-deposit box, a desk drawer or their attorney’s office.
The best of intentions can produce dismal failures. While having a living will is certainly a good idea, living wills are not the answer to a humane death for the vast majority of Americans. It is time to head back to the drawing board.
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The following fields overflowed: CREDIT = Art Caplan King Features Syndicate