The living will. Help or hindrance?

Abstract

The living will is a statement that directs physicians to act in certain ways during a patient's terminal phase of illness. The physician is instructed not to take measures that would prolong the life of the patient. The living will is designed to promote patient autonomy while removing onerous decision making from physicians and the patients' families. Experience with the living will indicates that it can either help or hinder clinical decision making. When appropriately implemented, the living will can perform its intended functions. When vague in terminology or applied to patients with uncertain prognoses, the living will can promote medical staff confusion. Adequate communication between patient and physician can improve the utility of the living will. Other considerations affecting the applications of the living will are discussed in detail.

KIE: After reviewing the intended functions of living wills in promoting patient autonomy and facilitating decisions on withholding treatment from the terminally ill, the authors analyze the extent to which living wills have proven useful in the clinical setting. They present two case studies: in one, the living will did facilitate decision making by the physicians and family members; in the other, it would have resulted in a premature cessation of treatment if an institutional ethics committee had not intervened. The authors suggest ways that physicians can best utilize living wills in making appropriate decisions on terminal care.