The Difference Between Living Wills and Durable Power of Attorney for Healthcare
I thought that I'd write about this because O'Reilly's refusal to sit back and allow himself and his listeners to be educated really got me yelling at the TV.
Click here for complete entry.Last week, Bill O'Reilly interviewed a bioethicist to discuss some of the ethical implications of the Schiavo case. At the end of his interview, O'Reilly advised all of his listeners to make sure they have a living will and he attempted to get confirmation of this strategy from his guest. When his guest, an expert on such issues, denied having one himself, O'Reilly criticized him repeatedly without letting him explain his reasons although he certainly tried.
I thought that I'd write about this because O'Reilly's refusal to sit back and allow himself and his listeners to be educated really got me yelling at the TV. In researching it (to make sure I'm not saying something wrong or stupid) I came across today's entry in the excellent blog Abstract Appeal run by Matt Conigliaro:
I've heard a certain "powerful" television host say repeatedly that he's written his wishes down and that's the end of it for him, and had Terri done so it would have been the end of it for her, too. I'm going to explain why he's wrong. Someone should. May as well be little ol' me.I've looked all over his site and can't find his answer. Perhaps he hasn't written it yet. Until he does, maybe my response will clarify this issue. When he posts his, I'll link it because I've no doubt his explanation will be more authoritative than mine!
Basically, a living will is a document written to give guidance about what should be done on the author's behalf in the event that he is unable to make medical decisions on his own. They're easy to get. You don't need a lawyer and they carry legal weight. The problem is, every situation is different and to draft a comprehensive document for all eventualities is virtually impossible.
There are simply too many parameters and end-of-life issues are far too complex. If you simply say "I don't want to be kept alive artificially if it looks like I'm not going to improve," is that enough? Not likely.
What does "if it looks like I'm not going to improve" mean? Medicine lacks certainty. What we're left with are probabilities. Is a 99% chance of improvement worth living for? A 1% chance? What about all the probabilities in between? Do you really want to specify such a probability in your living will?
And how much improvement do you require? Enough to walk and talk? Enough to run a marathon? Or just enough to breath on your own?
How much time do you want to give your doctors and family to establish whether you're going to get better or not? A few days? years? Again, do you really want to commit yourself in writing to a specific duration? And what if you begin to show signs of improvement? Would you want there to be a provision for altering this duration?
As you can see, the number of possibilities is virtually endless. Trust me, I've seen it. What seems very reasonable in a lawyer's office can seem incomprehensible when a medical crisis arises.
So what is the solution? A durable power of attorney for healthcare (DPAHC).
Basically, you pick a trusted family member or friend (often a spouse) to make medical decisions when you yourself are unable to. The advantage of this over a living will is that rather than consulting an obscure legal document, the medical staff has a sentient being to make decisions. The theory is that if you discuss in detail your feelings, philosophies, religious convictions, worries, etc. with the surrogate selected by the DPAHC, that person can acquire a gestalt for your true desires. They can then address medical issues real-time as they change. A DPAHC is therefore much more flexible than a living will.
For these reasons, I believe most bioethicists and attorneys experienced in such matters recommend a DPAHC over living wills. I will say that it's perfectly reasonable to put your thoughts on paper in the form of a living will for reference. But the actual decision-making should come from a living, breathing person who is capable of adapting to changing clinical situations.