Living Will and Will to Live
I want to emphasize again, a Living Will is not an end-all regarding autonomous medical decision-making. Often a Living Will written years before it is to be applied provides the physicians none or vague, ambiguous information about the will to live and desired final quality of life of the patient if the patient was aware of the current clinical situation being faced. What is needed is a written selection by a person of a Durable Power of Attorney for Healthcare, the legal surrogate. That selected surrogate becomes that person’s eyes, ears, mind and voice once the person becomes a patient and cannot communicate. Again, what the selected surrogate decides to the medical healthcare team is the patient speaking. Others, no matter how closely related do not have similar power and can only provide evidence of their understanding of the wishes and behavior of the patient when competent but their voices are for information only and not commands.
It is very important, therefore, that the patient finds an individual to be the selected legal surrogate who has an interest in speaking for the patient, who is free of any obvious self-interest when speaking for the patient and who has the intelligence and capacity themselves to make those substituted decisions when the patient is unable. This surrogate could be a spouse but it could be someone else. The most important point is that the person selecting the surrogate spend time, if possible repeatedly over time, discussing the person’s desires in general regarding making any medical decisions including those at potentially end of life. As time goes on, the person’s views of their goals may change and as they do, these should be discussed with the selected surrogate. Written notations in the Living Will should also be updated. The person selecting a surrogate should also identify another individual to be a substitute in case the primary surrogate is too ill and incapacitated to perform the role at the time of need or no longer wants the responsibility. This substitute proxy should also be kept informed. Moreover, family members should be made aware of who is the selected legal surrogate and also kept aware of the general wishes regarding care and treatment. If all of this is done, the physicians and others on the healthcare team should have a continuum of understanding of what the patient would have wanted and hopefully nothing on the order of the Schiavo case would occur. Any questions? ..Maurice.