In the twenty-first century, medical healthcare is the most advanced it has ever been, providing us with a vast range of health care options when we face challenging illnesses. But until sickness arrives on our own doorstep, we often shy away from considering the decisions we may have to make with regards to our health care. Even though 90% of Americans believe it’s important to discuss their end-of-life care wishes and those of their loved ones, according to one study, less than one in three citizens have written a Living Will.
The basic principle behind writing a Living Will (also known as an Advance Health Care Directive) ensures that you will receive the level of care you desire, even if you are not medically able to make those decisions when you fall ill. Giving your doctor and family clear instructions has multiple benefits, most important of all is that your preferences and values, ranging from do-everything-possible to do-not-resuscitate, are articulated while you are mentally and physically able to do so.
If you end up with a serious injury, a terminal illness, or fall into permanent unconsciousness without a Living Will, you may have absolutely no say in your end-of-life care, leaving some of the most intimate and personal decisions of your life to family members, doctors and the directives of the state instead.
Why is the Living Will so Controversial?
Perhaps attesting to the fear with which we approach this most morbid of topics, a huge controversy erupted in 2009 when Obama moved to include a measure in the Affordable Care Act which would reward doctors for having end-of-life conversations with their patients. The Republicans labelled the scheme “death panels” making comparisons with Holocaust programs of Nazi Germany. They were convinced the aim was to ration health care for the sick and dying, and suspected the motivation of “encouraging or forcing Americans to end their lives early to cut costs for the government.”
But many defendants of the measure assert that Obama’s Medicare health bill doesn’t include anything which rations health care or compares the worth of human lives.
Obama was trying to address an issue which haunts America’s healthcare system. Certainly, finance does play a role in his move. According to a revealing study cited in Time Magazine, roughly a “quarter of the overall Medicare budget is spent on the last year of recipients’ lives, with 40% of that money going to their final 30 days.” But it’s not so much the amount of money that’s spent but how it’s spent that deserves reconsideration.
So despite the vehement opposition, now Obama is bringing it back.
Regardless of the furious political debate around the issue of living wills and end-of-life care, it’s still a very important conversation to have with your doctor, whether or not the state is sponsoring.
What Options are Available to Me Within a Living Will?
Writing a Living Will means you can align your end-of-life care with your own preferences and values, and pre-empt and avoid any unnecessary suffering. You will have to think carefully about your choices regarding issues such as cardiopulmonary resuscitation (if your heart or breathing stops), artificial nutrition and hydration, machine-induced respiration, and other specified life-prolonging procedures. You can decide how long you’d like to be kept alive with such treatments (if at all), and you may also be invited to decide if you are willing to be an organ and tissue donor, or to donate your body for medical research.
You can also opt to have another document called a Health Care Power of Attorney, which assigns a trusted relative or friend to make healthcare decisions on your behalf when you are unable to do so yourself.
What Difficulties Can Arise if I Don’t Have a Living Will?
The problem is that the default mechanisms in place tend to promote that, if in doubt, doctors do all within their power to keep patients alive for as long as possible. This means aggressive and invasive treatments may be pursued, despite the fact they may be unlikely to radically lengthen or to improve quality of life for the patient. In fact, these treatments can often be harmful and painful, not to mention costly and emotionally burdensome for both the patient and family.
In a frank account of end-of-life care published in The Guardian, Doctor Ken Murray says that from a doctor’s perspective, “to administer medical care that makes people suffer is anguishing.” He goes on to expound that there are several reasons why doctors may find themselves in such a bind. Murray argues that, firstly, doctors fear litigation. They may do “whatever they’re asked to avoid getting in trouble.” Being sued for Medical Malpractice is undoubtably many doctor’s worst nightmare.
Furthermore, doctors may struggle to have honest conversations with families. It can be difficult to inform family members that their loved one is unlikely to recover. A doctor does not want to seem like they are ‘giving up’ on the patient or not trying their hardest. What’s more, a distressed and overwhelmed family, when presented with a complex array of medical choices available for their loved one, may opt for having “everything done” without fully understanding the implications of that decision.
Most burdensome of all, in the absence of a clear Living Will stating the patient’s wishes, is when the family disagrees about the course of action that the patient would have wanted. In one notorious case in 2005, a husband finally gained the right take his wife off life support after 15 years of her lying in a coma and a lengthy court battle with the woman’s parents.
In the Final Conclusion…
Murray asserts that “almost anyone can find a way to die in peace at home, and pain can be managed better than ever.” If the idea of pursuing life-prolonging treatment against the odds and being hooked up to a life-support system for a long time with little chance of waking up, then writing a Living Will may be one of the best decisions you ever make.
While modern medicine is an incredibly advanced and powerful field, having a Living Will and a Power of Attorney in place helps to restore consideration of the physical, spiritual, emotional and financial needs of the patient.