A Call for Better Living Wills

November 28, 2006

[some say the current format is too vague, and may kill the

salvagable.]

Medical Due Diligence: A Living Will Should Spell Out the Specifics

By JANE E. BRODY

Published: November 28, 2006

When I ask people whether and how they have made preparations for

the ends of their lives, the most frequent response is, " Well, I

have a living will. " But chances are they are unaware of the serious

limitations inherent in such a document and how it is likely to be

interpreted by medical personnel should a life-threatening crisis

arise.

A living will is an advance directive, a document that states your

wishes about how you should be cared for at the end of your life. It

is meant to be activated when you are unable to say what you do or

do not want to be done medically — if, for example, you are in a

terminal condition, your heart and breathing cease, you are in a

persistent vegetative state because of severe brain damage or you

are too demented to understand the situation.

A living will lists your general preferences for or against life-

prolonging treatment like cardiopulmonary resuscitation if your

heart suddenly stops, or mechanical respiration if you cannot

breathe well enough on your own. But the simple statements contained

in most living wills, more often than not, are hard to apply to the

great variety of medical situations that can arise.

For example, let's say you're a 70-year-old active retiree with

congestive heart failure who develops pneumonia and has trouble

breathing. You go to the emergency room, living will in hand,

stating that if you become terminally ill, you do not want to be

treated with antibiotics or placed on a ventilator.

Open to Misinterpretation

The admitting physician reading your living will may interpret it as

a " do not resuscitate, " or D.N.R., statement, meaning you want no

treatment for your life-threatening infection, in which case you

would probably die. Yet a course of antibiotics and a week or so

with assisted breathing could restore you to your previously active

state.

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