Living Wills – Interpretation Problems

By a living will I am referring to instructions written out by a person to give direction to others about health care decisions in the event the person becomes unable to speak for themselves.

Writing in a way that will clearly be interpreted by others, as you intend your instructions to be interpreted, can be a problem.  Consider the following exert from a living will.

If I become incapable of expressing my wishes and my physicians declare me to have a condition from which I will not recover, then I wish to have all life prolonging procedures withheld, including, but not limited to, artificial nutrition and hydration, and life support including intubation and ventilation.

There are a number of questions raised by such a statement.

What does “a condition from which I will not recover mean?” Does “not recovering” mean that it will result in death? What about incurable medical conditions from which you will not recover but that can be controlled for a number of years, such as diabetes? Assuming that you are referring to conditions that are expected to lead to death in the near future, what period of time would be considered short enough to be included in the mentioned conditions? Is this a condition where death is expected within weeks, months, or years?

What things should be classified as life prolonging procedures? Who should decide?

What does artificial nutrition mean? Does this include having to have food artificially thickened so that you will not aspirate? Does this include having food artificially ground up or puréed? What about having food spooned in by someone else, rather than you spooning it in yourself, as you naturally do?

What about hydration? Does this just refer to “artificial” hydration or does it refer to all hydration?

To what extent must you be incapable to express your wishes? What if one persons interprets your gestures and actions as a valid way of expression your wishes and another person does not?

Is not “life” a condition from which each of us will ultimately not recover? All of us are headed for physical death. What if you have a stroke that limits your ability to move about and your ability to freely speak, making it difficult for you to communicate, that does not affect you ability to swallow food, and makes you dependent on others bringing food up to your mouth? Are you then asking others to withhold food and fluids from you and allow you to starve to death.

Do we really know how we will feel about being in a situation before we have experienced what it is like to be in it?  There are people who live in very difficult physical conditions who appear to be happy?

Should we be more concerned about the way we think we will feel if we are to end up in a certain condition or should we be more concerned about how others will feel?

These are some of the questioned raised by living will statements like the one recorded above.  I hope that these question are helpful when it comes to avoiding some of the pitfalls of writing a living will.

In raising these questions, I have not commented on the question, “To what extent should we be trying to direct what happens to us as we follow that path of life?”  But that is for another posting.  Some thoughts on this can be found in the posting titled Living Wills – My Will or Thy Will Be Done?


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