by Maria Gallagher
LifeNews.com Staff Writer
August 22, 2004
Pittsburgh, PA (LifeNews.com) — Living wills are not a cure-all for end-of-life issues, according to a recent study, which shows that such advance directives may often be ignored.
Given hypothetical situations involving imaginary patients with living wills, nearly two-thirds of the physicians surveyed indicated they would not follow the orders.
The doctors said they would overrule the documents if there were hopeful prognoses for the patients, or if family members expressed different views.
Alan Meisel, a professor of law and bioethics at the University of Pittsburgh, says the findings come as little surprise.
"There have been many studies over the course of the last decade which suggest that advance directives, especially living wills, are not particularly helpful," Meisel told Health Day News.
That’s because it’s difficult for an individual to predict what medical challenges he or she will face.
"It’s impossible for people to fine-tune what they want and don’t want in the way of medical care in advance," Meisel told Health Daily. "They never know what the situations will be. They’re particularly complex and constantly changing."
In 65 percent of the cases involved in the study, doctors said they wouldn’t follow advance directive orders. The study’s authors said the physicians wished to consider other factors, such as hope for recovery, perceived quality of life, and the wishes of family and friends.
Researchers sent surveys to 250 doctors asking them how they would handle six hypothetical situations involving seriously ill patients who could not make their own health care decisions. Some 117 doctors responded to the surveys.
Doctors note that the instructions provided in such directives can be vague. For example, a patient might ask for "no heroics," without defining the meaning of the phrase.
In other cases, a living will might state that a patient does not want to be placed on a ventilator to assist with breathing. But when the patient enters the hospital, a doctor might violate the order, saying the ventilator is needed for only a few days.
Still, there can be value in patients making their desires for lifesaving treatment known ahead of time, according to experts in the field of end-of-life legal issues.
"I think people need to create advance directives in which they say, ‘I don’t want to be dehydrated to death and have my food taken away if I become cognitively disabled,’" Wesley Smith, an attorney specializing in bioethics issues, told LifeNews.com last year.
"We always hear about doing away with treatment, but they can also be used proactively to say, ‘Look, don’t take any actions to intentionally kill me, ’" Smith added.
The National Right to Life Committee has crafted a legal document called the "Will to Live," which "makes clear one’s desire not to be starved or denied lifesaving treatment if unable to make health care decisions for oneself," said Burke Balch, NRLC’s director of medical ethics.
The International Task Force on Euthanasia and Assisted Suicide recommends a durable power of attorney for health care as a life-affirming alternative to the living will.
"You name a trusted individual to make decisions for you if you can’t make them for yourself either temporarily or permanently," Rita Marker, the group’s director, told Focus on the Family.
"With a living will, what you’re essentially doing is giving all authority to an unknown physician," Marker added.
The issue of advance directives has received quite a bit of publicity because of the controversy surrounding the case of Terri Schiavo, a severely handicapped Florida woman at the center of a euthanasia debate.
Her estranged husband wants to end nutrition and hydration for her, but her parents are fighting to keep her alive, saying that’s what Terri would have wanted.