Tuesday, December 30, 2008

Problems with Living Wills

In keeping with my theme tonight, I am going to share with you some problems with Living Wills. Hopefully, after reading this, you will better understand what a Living Will is and what it is not. This will make you a better informed caregiver or patient depending on your particular situation.

Let me start my saying that Living Wills are big business. Lawyers, politicians, etc., all have a hand in these. There are Living Will Registries in some states and the Verichip can have your living will and DNR put on it.

What is a Living Will?
Living Will - A written document that allows a patient to give explicit instructions about medical treatment to be administered when the patient is terminally ill or permanently unconscious; also called an advance directive. Also called "a durable power of attorney," it is a document authorized by statutes in all states, in which a person appoints someone as his/her proxy or representative to make decisions on maintaining extraordinary life-support if the person becomes too ill, is in a coma or is certain to die. In most states the basic language has been developed by medical associations or other experts and may provide various choices as to when such maintenance of life can be terminated. The decision must be made in consultation with the patient's doctor. The living will permits a terminal patient to die in dignity and protects the physician or hospital from liability for withdrawing or limiting life support.

Here a a few problems with the Living Will:

1. It can be easily misinterpreted as a DNR order. Please make sure that any hospital, Doctor, nurse, or other health care provider understands what a Living Will is. If there is any confusion at all, you may find that the quality of care or safety of your loved on is at risk. If your loved one suffers because their Living Will or DNR order was misinterpreted, chances are you will never be told of this.

2. These documents are usually template forms. They are broad forms with no individualized specifics. A person in their 30s or 40s should not have the same Living Will as a person in their 70s or 80s.

3. They are often filed away and forgotten. You should change your Living Will as your life changes or as you grow older. If your loved one is elderly, this should be done every 6 months or as their health changes.

4. Informed Consent. You should be able to give informed consent as to what your loved one desires regarding their end of life decisions. This is a decision you really can't afford not to talk with your loved one about. The emotional cost is just simply too great. If you use an attorney, he is not going to be able to answer all of your questions. He just isn't armed with enough information. This is not the Physician's job. Legally, they should not be involved at all with this decision. Unfortunately, some Doctors feel that it is part of their job, and they are left to make this decision and later families regret the decision they allowed him to make and wind up suing.

5. Who is the attending physician? In the eyes of you or your loved one it may be their family doctor. In the eyes of the law, it is whomever is treating them at the time this issue comes up. So it could be the EMT, Emergency Room Doctor, etc.

6. What is terminal? Terminal - Causing, ending in, or approaching death; fatal. Is your loved one considered terminal? This is a question to ask before a DNR order is enforced. Many people do not read a Living Will. They skip down to the section that states what your loved one does/does not want in regards to their care. Please make sure that the entire will is read. Highlight the points you want to stand out if necessary.

7. Personal view is interjected. Remember this is what your loved one wants. Do not be swayed by personal opinion. You have to live with any decision that is made. Make sure that you can. Also, the people attending to your loved one are human. Their personal opinion may encroach on their duties as to the care given to your loved one. You really need to talk with the people attending your loved one to ensure that the best care is being given to them.

A Living Will is effective when it is written. It is activated when something triggers it. Cancer, life threatening occurrence, etc.

Another issue with Living Wills is that physicians don't spend enough time discussing this because they feel they are not compensated enough for their efforts. Now I am going to try and not get on my soapbox about this. But if you are talking with a Doctor that is not willing to give you the time you need to get this right, you need to let them know in no uncertain terms. Do not be rude, use some tact. If this does not work, look for another Doctor. Everyone dies even your Doctor. Sometimes we all need to be reminded of our own mortality. Sometimes they are just as uninformed as you are so it can be a learning process for all of you. Another reason is fear of lawsuits.

The best course of action in regards to your Living Will is this: Leave it at home until it can be determined just exactly what the prognosis of your loved one is. After you have determined this, then you can decide whether or not to bring your loved one's Living Will to the Doctor or Nursing Home or hospital.

I hope this has helped you better understand the Living Will. If you want to hear a physician speak on this subject and more you can go to this site.


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