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Highlights:
Our Deepest Fears | Living Wills Can Fail | Surrogates Can Let You Down | A Legal Peaceful Choice | Why Caring Advocates

Susan Ponder-Stansel's grandmother wrote up her advance directive and passed the document out to every relative and health care professional she could think of. It stated clearly to NOT attempt to resuscitate and that she wanted to die in her own home instead of being transported to the hospital.

But her heart stopped while she was being bathed by a hired caregiver who did not know about her advance directive and dialed 911. The Emergency Techs followed their legal mandate to try to save her life as they found no advance directive. So did the hospital.

A few hours later, her grandmother had bruises on her arms from attempts to insert IVs, and broken ribs from attempts at CPR, but she was still unconscious.

* * * * *

In March 2002, Margaret Furlong, aged 82, was transferred from an Oxnard nursing home to St. John’s Regional Medical Center in California. Her family contends that she provided the hospital and her doctors with a copy of her written health instructions upon admission, and that these instructions clearly indicated that she did not want to be resuscitated.

Yet the hospital and doctors caring for Margaret Furlong ignored her specific wishes.

According to the appeal brief written by family’s attorney Jody C. Moore, Margaret Furlong “thought long and hard about the kind of medical care she wanted at the end of her life. Margaret took every step possible to ensure that her profoundly personal wishes on this momentous, final matter would be known and respected. Defendants violated their duty to ascertain Margaret’s clear wishes, and consequently defendants did not honor those wishes. As a direct result, Margaret died the lingering death she had sought to avoid, a death filled with invasive, painful, undignified treatments.”

Her family is appealing on the basis of elder abuse. [Ventura County Star, 2004; Case number B172067, plead by attorney Jody C. Moore, March 18, 2004.]

Enough. The Failure of the Living Will is the emphatic title of a strongly worded article by Fagerlin and Schneider [2004] who may believe their article has hammered the last nail into the coffin of the Living Will, which they vehemently recommend abandoning. Their basic premise is: “If, as we have argued, patients sign living wills without adequate reflection, lack necessary information, and have fluctuating preferences anyway, then living wills will not lead surrogates to make the choices patients would have wanted.” Their conclusion is: “people who sign living wills have generally not thought through its instructions in a way we should want for life-and-death decisions. Nor can we expect people to make thoughtful and stable decisions about so complex a question so far in the future.”

Hardin and Yusufaly [2004] surveyed physicians and found that their decisions were not consistent with the Living Will instructions about two-thirds of the time. Instead, they led other factors trump what the patients stated were their wishes.

Only 35 of 135 patients had Advance Directives in a study at a Florida hospital, but many of those that did were judged "vague and required further clarification" or "nondirective" rather than as meaningful documents. [Gilbert et al 2001.]

In another study, Living Wills known to exist were found in the medical charts of patients only about 32% of the time [The Missoula Demonstration Project ]. Other studies have shown that the Living Will could only be found one-quarter of the time when physicians needed to make critical life-or-death decisions. [Monmaney, 1995]

But the most practical reason why Living Wills do not work is that the attending physician can be threatened by the vehement relative who is more likely to survive the patient and who might file a lawsuit if the doctor does not follow his or her orders.