News Articles

End-of-life decisions: ‘The key is communication’

WASHINGTON (BP)–Americans’ interest in living wills has soared since they observed the circumstances of Terri Schiavo’s tragic demise, but any hope such documents are a panacea for the thorny questions of care for the incapacitated or those near the end of life apparently is misplaced.

Basic living wills, pro-life bioethicists say, are: 1) marked by a presumption for death rather than life, 2) may fail to provide specific direction in some instances and 3) may, along with other advance directives, be challenged by healthcare providers.

Under the laws of all but 10 states, doctors and hospitals may be able to ignore requests in advance directives for treatment, food and water, according to a recent study by the National Right to Life Committee. “Increasingly, health-care providers who consider a patient’s ‘quality of life’ too low are denying life-preserving measures against the will of patients and families — and the laws of most states provide no effective protection against this involuntary denial,” the report concluded.

So what should a person who holds to a sanctity-of-life ethic do in what appears to be an increasingly challenging effort to assure his wishes are followed?

1) Select a person you trust to make medical decisions for you and communicate your desires to him.

“The key is communication,” bioethicist C. Ben Mitchell says. “Documentation is just added insurance. Presumably, you would choose a person who shares your biblical values about the sanctity of human life and with whom you have had a discussion about end-of-life decisions. Talk about what you would and would not want at the end of your life.”

2) Designate that person as your agent, preferably through a durable power of attorney for healthcare.

“In my view, the durable power of attorney is a better advance directive than the standard living will,” says Mitchell, senior fellow at the Center for Bioethics and Human Dignity and a consultant for the Southern Baptist Ethics & Religious Liberty Commission.

The durable power of attorney, which requires notarization but not a lawyer, has some advantages over a living will. “The durable power of attorney becomes effective whenever a patient is unable to make decisions, not just when the patient is terminal,” Mitchell says. That means a person who is mentally incapacitated or in a coma, but not necessarily near death, would have an advocate as decisions are made. “He or she will want to act in your best interest and in a way that is consistent with how you would act if you were able to make your own decisions.”

3) If you desire a further document to indicate your desires, complete a “Will to Live.”

The NRLC offers the “Will to Live” as a pro-life alternative to the standard living will. “Be sure that your proxy decision-maker understands the provisions in your ‘Will to Live’ and agrees with your decisions,” Mitchell advises. “Advance directives are not the end of the story; they are the beginning. That is, they should be used to encourage you to talk about what you would want and would not want done medically at the end of life. The most important thing is that you talk to your loved ones, pastor and doctor about your wishes.”

The NRLC website, www.nrlc.org, provides a version of this pro-life advance directive for each state. A new report on how closely advance directives are followed in the states also is available.

Also at the NRLC website is the article, “Why Are You at Risk If You Don’t Sign a Will to Live?” by Burke J. Balch of the Robert Powell Center for Medical Ethics.

“The Hippocratic Oath has not been taken at medical school graduations for well over two decades now,” Balch notes. “The American Medical Association, regarded by most as the voice of organized medicine, has been in the forefront of those insisting that withholding of lifesaving medical treatment, as well as ‘artificially’ provided food and fluids, is appropriate medical practice.”

Balch noted that a survey of physicians in the Pacific Northwest reported in the Archives of Internal Medicine found that the doctors’ preferences for whether their older patients should be resuscitated was “significantly correlated” with the doctors’ assessments of the patients’ “quality of life.” “Significantly, the study also found that, compared with the patients’ own assessments, the doctors substantially underestimated their quality of life,” Balch notes.

Two other organizations also provide help for people seeking to make decisions on end-of-life care from a sanctity-of-life viewpoint and to communicate those wishes to loved ones and health-care providers:

— The Center for Bioethics and Human Dignity (www.cbhd.org), which provides guidance through various resources. Some are available on its website and some must be ordered. An Advance Directive for Health Care is available as well as an introductory explanation of the form.

— The Christian Medical and Dental Associations (www.cmdahome.org), which offer a variety of resources, some on their website and some by order. An advance directive form is available, along with a guide in a question-and-answer format.
Reprinted from Faith & Family Values, journal of the Southern Baptist Ethics & Religious Liberty Commission.