MGordon_MD
Novice
/ Moderator
Sep 24, 2007, 1:20 PM
Post #1 of 1
(1253 views)
Shortcut
|
By Dr. Michael Gordon
Some time ago, I wrote a column on living wills in which I raised some concerns about their usefulness in helping individuals and family caregivers make end-of-life decisions when a person is no longer able to speak for himself or herself.
There has been a strong movement supporting living wills over the past three decades, and many organizations, facilities and health care spokespeople have promoted them as a useful method of assuring respect for the ethical principles of autonomy and consent to treatment. It was anticipated that if people stated what they would want under a given set of circumstances, those making decisions would know what to do, and this would respectfully eliminate uncertainty. Health care professionals believed living wills would translate into clearer decisionmaking in often trying situations that are sometimes fraught with family conflict and guilt.
But from laudable concept to real-world implementation, something went seriously awry. In addition to what appears to be a profound reluctance by individuals to document their wishes for the future, there is also the question of to whom a living will speaks – initially, doctors thought that since they were often consulted on the content of living wills, they would also clinically interpret them. But in most jurisdictions, the living will is directed to the surrogate decision-maker, usually a family member, rather than the doctor.
During the famous case of Terri Schiavo, some experts suggested that if she had written a living will, all the challenges that were undertaken by her family, community and religious groups, and governmental officials could have been avoided. After her case, organizations that provide documents such as living will “kits” experienced a surge in requests for them.
The July 3 issue of the prestigious Annals of Internal Medicine contained an article by Dr. Henry S. Perkins titled, “Controlling Death: The False Promise of
Advance Directives” (advance directives are known in lay terms as living wills). His conclusion from reviewing 30 years of experience with living wills is that they haven’t fulfilled their initial promise, which was to remove the uncertainty from end-of-life decisions and, therefore, to allow individuals to plan for their futures.
The author explores why living wills haven’t fulfilled their promises. The reasons include the fact that few people actually fill them out, and physicians with whom patients and their families might wish to discuss the complex clinical events of end-of-life care are rarely meaningfully involved in such planning. As well, directives are often completed by individuals and family members, with perhaps a lawyer being involved, none of whom can discuss the implications of a directive’s wording or what might occur in end-of-life situations. For example, panic might result in a family requesting a patient’s transfer to an emergency room when the person might have indicated a preference to die at home in “dignity and comfort.”
Another point made in the article is that the language used in living wills is often vague (e.g., “no heroics,” “comfort care only,” “dying with dignity”). Family members might interpret words or phrases differently, as might various health care providers.
The author feels that the uncertainty that often surrounds end-of-life care is best approached by open communication with those who will likely be involved in final decisionmaking. Difficult though they may be, discussions should focus on preferences, wishes and values. Such knowledge and understanding can help guide loving family members to do the “right thing,” even in situations of complexity and uncertainty. Trying to capture it all in a written living will alone has not, so far, achieved those laudable and desirable goals, and it’s not likely to do so in the future.
This article was originally published by The Canadian Jewish News
Dr. Michael Gordon, is vice-president of medical services at Baycrest in Toronto, Canada, and co-author with Bart Mindszenthy of Parenting Your Parents.
Parenting Your Parents is available in bookstores and online at: Indigo-Chapters, Amazon and Barnes & Noble.
For bulk orders email info@dundurn.com. Call: 416-214-5544 or Fax: 416-214-5556
---
(This post was edited by MGordon_MD on Oct 23, 2007, 9:59 AM)
|
MAIN
SEARCH
WHO'S 
LOG 
