Living wills just aren’t worth the paper they’re printed on, say two experts who have looked at how the documents are really used. The documents may lull risk managers into a false sense they have avoided potential difficulties by encouraging patients to address them up front, they say.
Those conclusions stem from a comprehensive review of hundreds of studies of living wills, end-of-life decisions, and the psychology of making choices by Angela Fagerlin, PhD, a research scientist with the University of Michigan (UM) Medical School and Veterans Affairs Ann Arbor Healthcare System, and Carl E. Schneider, MD, JD, the Chauncey Stillman Professor of Law at the UM Law School and professor of internal medicine at UM in Ann Arbor.
Schneider and Fagerlin recently released a study in which they analyzed how living wills were actually used and how much they reduced the end-of-life debates they were intended to address.1 Their basic conclusion was that a living will is "a nice idea, but it doesn’t work," Schneider says.
The living will, Fagerlin notes, was designed by bioethicists who wanted to give patients a chance to spell out what treatment they would want and what treatment they would reject if they became unconscious or unable to make their own decisions for some other reason. The idea of the living will is to allow people to maintain control even at the end of life but they have proven to be impractical, he says.
Fagerlin says there is no evidence that living wills work, yet health care providers spend thousands of dollars every year promoting them to patients, partly because the law requires them to and partly because there is a strong belief that living wills are "the right thing to do."
Schneider urges risk managers to reconsider how living wills are promoted in their institutions because he says they are, at best, a waste of time. But he goes a step further and suggests that you are doing your patients a disservice by encouraging them to sign something that ultimately will not be useful.
"I do think it is a kind of malpractice to be pretending to patients that these documents are really going to have an effect," he says. "People are making these really serious decisions based on little information, seeing it as just one more form to fill out. And you’re telling them that they have addressed a very serious matter when in fact they have not."
It is unlikely that patients could find a successful way to sue the provider when a living will does not fulfill its promise, but Schneider says risk managers are fooling themselves if they think that living wills will help them avoid thorny situations like the Schiavo case.
Reference
1. Fagerlin A, Schneider CE. Enough: The failure of the living will. Hastings Center Report 2004; 34:30-42.
Living wills just arent worth the paper theyre printed on, say two experts who have looked at how the documents are really used.
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