Living Wills Need to be Specific

Extremely important observations about living wills are made in Jane E. Brody, Medical Due Diligence: A Living Will Should Spell Out the Specifics, NY Times, Nov. 28, 2006.

[T]he simple statements contained in most living wills, more often than not, are hard to apply to the great variety of medical situations that can arise.

For example, let’s say you’re a 70-year-old active retiree with congestive heart failure who develops pneumonia and has trouble breathing. You go to the emergency room, living will in hand, stating that if you become terminally ill,  you do not want to be treated with antibiotics or placed on a ventilator. * * *

The admitting physician reading your living will may interpret it as a “do not resuscitate,” or D.N.R., statement, meaning you want no treatment for your life-threatening infection, in which case you would probably die. Yet a course of antibiotics and a week or so with assisted breathing could restore you to your previously active state. * * *

Dr. Mirarchi * * * has studied how health professionals interpret living wills and found that the overwhelming majority think they mean that the patient wants to be treated as D.N.R., when in fact aggressive life-saving interventions could restore some patients to their previous state of health.

Accordingly, he has devised a more comprehensive living will — an advance directive he calls a medical living will with “code status” — that people can fill out in consultation with their physicians and perhaps an attorney to help assure they get the kind of care they would want if they could ask for it. The “code status” tells medical personnel exactly how someone wants to be treated in a life-threatening medical emergency, removing the guesswork.

If, for example, you choose “full code,” the directive would say: “I would like to receive all lifesaving and supportive measures should an emergency arise. Should my condition fail to improve and I am no longer able to make my own decisions, then I would like my advance directive to be active and followed.”

Only at that point, then, would individually stated requests be honored, such as not being resuscitated, defibrillated, ventilated, fed by tube, transfused, given antibiotics or placed on a dialysis machine.

Your living will should also state that you (or your heirs) will not sue health care workers or facilities for following your stated wishes. The document can also call for a two-physician conference before life-prolonging treatments are withdrawn. The final document should be notarized.

Special thanks to Matthew B. Bogin (Rockville, Maryland) for bringing this article to my attention.