Rethinking the Wisdom of Living Wills

In her article Back Off! I’m Not Dead Yet, Washington Post, Oct. 14, 2007, at B01, Charlotte Allen describes her recent experience of going through breast cancer treatment while being constantly questioned about having a living will. Allen attributes the hospital staff’s ceaseless inquiries to a 1999 federal law, requiring healthcare facilities to educate patients about living wills.   She explains:

When I showed up at the hospital for some pre-surgery medical tests, one of the receptionist’s first questions was, “Do you have a living will?” The form she gave me after I shook my head was as complicated as a tax return. There were numerous boxes for me to check specifying a range of conditions under which I might like to have a Do Not Resuscitate order hung over my hospital bed, whether I would want to be denied “artificial” food and water under some circumstances, what I thought about being taken off a ventilator, and so forth.

Furthermore, I found something weasely in the way all those options were presented, as though my only real choice were between being dispatched into the hereafter at the first sign of loss of consciousness or being stuck with as many tubes as needles in a voodoo doll and imprisoned inside a ventilator until global warming melts the ice caps and the hospital washes out to sea. I found the box on the form that said “I decline a living will” and checked it. * * *

[W]hen I contemplate the concept of “dying well,” I can’t avoid the uneasy feeling that it actually means “dying when we, the intellectual elite, think it is appropriate for you to die.” * * *

The problem is that nowadays there is simply no societal agreement on how people who are sick or disabled beyond hope of cure ought to be treated. Many people, especially highly educated, nonreligious people, think that “physician-assisted death” is exactly the right way to go — or to send off your unconscious mother. If you think that bioethicists will erect safeguards against this sort of thing, think again.

As far as I can tell, bioethicists exist for the most part to do some moral chin-pulling before giving the green light to whatever consensus the rest of the elite have reached. * * *

Living wills, it would seem, are effective only if they happen to comport with doctors’ and bioethicists’ own theories about what is best for the patient anyway. For this reason, the authors of the Hastings study propose that instead of filling out a living will, people execute a durable power of attorney, a simple document that entrusts decisions about end-of-life care to a relative or friend who shares the signer’s moral beliefs about death and dying.

Allen also discusses the increasing popularity of physician assisted suicides. This method of “good death” is now legal in Oregon and is in effect endorsed by former opposition, American Academy of Hospice and Palliative Medicine. Personally, Allen is not in favor of having a living will, and when the time comes, she does not want to “die well,” just die in peace.