Can "Living Wills" Work?
Bill Colby, JD
Senior Fellow, Law and Patient Rights
bcolby@PracticalBioethics.org
Next Monday’s American Medical News includes an article that examines living wills. [Link below.] The gist of the article is that living wills don’t work. One of my resolutions for our Bioethics Center is that in 2009 we will work to fix this problem.
In 1975 American society began in earnest the discussion about something the media named the “right to die.” A lawsuit over the ethics of turning off the respirator for a woman named Karen Ann Quinlan hit the national news. The following year, California passed the first living will law. In the years that followed, other states passed living will and all kinds of end-of-life laws – durable power of attorney for healthcare, surrogacy, DNR, brain death definitions, and more.
I interviewed Missouri legislators in the 1980s as potential trial witnesses for the Nancy Cruzan case. Those legislators thought that when they passed the 1985 Missouri living will law, they were “solving” cases like Nancy’s. Lawmakers who passed the 1990 federal Patient Self-Determination Act thought the same thing.
But laws by their very nature have limits. I think the focus of the AMN article is right. We need to simplify the “legal part” at the end-of-life. And we need to urge people to do a much better job of talking to one another.
We will be digging for some creative solutions at this Center to do just that in the months ahead. Stay tuned.
What do you think? Please share and view comments by clicking here.
Link:
Defective directives? Struggling with end-of-life care
Kevin B. O'Reilly
American Medical News
January 12, 2009
"There's always a question of what exactly the person meant and whether their current clinical circumstances warrant a change in plans," said Dr. John Lantos, John B. Francis Chair in Bioethics at the Center for Practical Bioethics.
Senior Fellow, Law and Patient Rights
bcolby@PracticalBioethics.org
Next Monday’s American Medical News includes an article that examines living wills. [Link below.] The gist of the article is that living wills don’t work. One of my resolutions for our Bioethics Center is that in 2009 we will work to fix this problem.
In 1975 American society began in earnest the discussion about something the media named the “right to die.” A lawsuit over the ethics of turning off the respirator for a woman named Karen Ann Quinlan hit the national news. The following year, California passed the first living will law. In the years that followed, other states passed living will and all kinds of end-of-life laws – durable power of attorney for healthcare, surrogacy, DNR, brain death definitions, and more.
I interviewed Missouri legislators in the 1980s as potential trial witnesses for the Nancy Cruzan case. Those legislators thought that when they passed the 1985 Missouri living will law, they were “solving” cases like Nancy’s. Lawmakers who passed the 1990 federal Patient Self-Determination Act thought the same thing.
But laws by their very nature have limits. I think the focus of the AMN article is right. We need to simplify the “legal part” at the end-of-life. And we need to urge people to do a much better job of talking to one another.
We will be digging for some creative solutions at this Center to do just that in the months ahead. Stay tuned.
What do you think? Please share and view comments by clicking here.
Link:
Defective directives? Struggling with end-of-life care
Kevin B. O'Reilly
American Medical News
January 12, 2009
"There's always a question of what exactly the person meant and whether their current clinical circumstances warrant a change in plans," said Dr. John Lantos, John B. Francis Chair in Bioethics at the Center for Practical Bioethics.
posted by Practical Bioethics at
11:05 AM
2 Comments:
Thanks for your comments. I look forward to seeing what the Center cooks up this year. Also nice to discover the blog. I'll be reading.
I agree that living wills rarely speak in a helpful manner to the actual situation patients and families face. Palliative care providers find that the most useful discussion to initiate with the family (or proxy) is to describe what an acceptable quality of life is for this individual. Talking about the person, his love of gardening, her love of reading or doing crossword puzzles, his avowall that he would never want to live in a nursing home, etc., helps the family and team to make a best attempt to say whether or not this person is likely to achieve an acceptable quality of life. Obviously, talking is the missing link in the picture. But it might be useful if an advance directive asked the person to identify their minimal quality of life requirements, in their own words.
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