You heard me correctly. Do not get a living will. This is a difficult thing to propose. In the aftermath of the Terri Schindler-Schiavo case it seems practically mandatory that each and every one of us go and get one. The accepted wisdom is that having a living will would prevent a situation like Terri's from happening to us. To many people that means that they don't want crazy fundamentalists and elected officials messing around with their wishes. That's fair enough. But many others want to ensure that they will be treated and allowed to live under the best care available should they become disabled, even if an interested party thinks that they should go ahead and die. It's to the latter class of people that this warning is directed.
I am an attorney, and don't expect to see this article greeted warmly. Indeed, will be a turncoat because even if an attorney charges only 50 or 100 dollars to prepare a living will, if
everybody has to do it now, that is a pretty good stream of income. I expect, rather, to be vilified as a cretin, a rube, a legal heretic, and other derogatory nouns as well. I feel a little like the character in the 1973 movie who first declares, "Soylent green is
people". The piece you are reading is not likely to be popular in the current climate.
Here is why I believe it to be a bad idea to get a living will right now. Let's start from the default setting; that is, if you become disabled and can no longer express your wishes, and do not have a living will, the common law, decency, tradition, and the ethics of the medical profession will err on the side of trying to heal you and of preserving life. That's not a bad default setting, if you indeed value your own life.
Before I explain what the now en vogue and practically mandatory living wills actually say and do, I'd like to provide some context for my conclusion. It is axiomatic that lawyers and judges can take practically any words with otherwise simple meanings and turn them into other meanings and previously uncontemplated conclusions, and they do so at will. If you get words like, for instance, "The Congress shall make no law restricting free speech" before a judge, it is quite likely to come out meaning "you may not run political ads against an incumbent in the last 60 days of a campaign."
That's how it is when people attempt to reduce human desires and behavior, and yes, moral judgments, to a piece of paper. For example, I have long thought that the various codes of ethics regulating the behavior of attorneys do not, in fact, cause bad lawyers to behave better, or cause good lawyers to be the best they can be. Instead, it gives lawyers a road map for precisely what they must do and say to get away with bad behavior. They don't require that attorneys do the right thing, instead they inform them that "if you don't do this, or this, in precisely this way, you will not get in any trouble." And so it seems to be with evolving field of living wills and the medical profession. They do not in any way require that your wishes actually be fulfilled, but instead provide the mechanism to get around what may be your wishes.
Today I read the Bar-sanctioned model living wills available on the websites of the Florida, New York, and California bar associations. These three big states are bellwether states and a good indication of where all of us are heading.
As ground zero for the Schiavo effect; and since all three state's living wills are quite similar in practice, I will review Florida's suggested living will. I invite you to look it and the other up for yourself. Florida's is one page long, and requires one to place check marks in up to four places. Your first choice is to pick one or all of the following: "if I have a terminal condition, if I have and end stage condition, and if I am in a persistent vegetative state."
What "terminal condition" means is not defined. Presumably it would apply if you have inoperable cancer, or any number of conditions that are always terminal (like being born), no matter what the prognosis is as to how long you might yet live. These options also do not make any mention of whether medical care might prolong your life, regardless of prognosis.
Once you've chosen from among one or all of those conditions, not defined, you then check a box indicating that you would either desire or not desire to have food and water withheld from you. There are no other options on the Florida Bar's favored form for a living will. There is no distinction between mechanical life support, such as a ventilator, and food and water. If you indicate that you do desire food and water withheld, then the doctors can do pretty much whatever they want to do with you. If you indicate that you do not want food and water withheld, that still leaves wide open the question of whether or not they have any duty to provide any other treatment at all. Words like "heroic measures" do not appear on this form; your choices are, dehydrate and starve me to death, or not. There is no in-between.
What's more, and this is where it gets interesting, the trigger for your "wishes" to be carried out is when your "physician and another consulting physician have determined that there is no reasonable medical probability of my recovery from such condition". Who your physician is is likely to be accidental. He or she will be whomever a hospital happens to assign to your care, most likely, and the consulting physician will most likely be a friend and colleague of the first physician, and will probably work in the same hospital. The form does not require any review of their opinion nor does it state any particular standard of proof. It could simply be on the basis of whim, or even malice, so long as they have "determined" their opinions.
And how shall they determine whether or not you are hopeless and thus should die? The standard on the living will form is "reasonable medical probability." That seems reasonable, but in practice, it means only one thing: your wishes are not the driving force in your care under a living will, rather, your signature on your living will gives the doctors the ability to stop treating you and watch you die, period. If the doctors go to court and tell the judge that there is a "reasonable medical probability" that you will not recover from your condition, it is very, very unlikely that a judge will be in a position to disagree with their testimony and rule that they are incorrect.
Thus, in the case of the living will forms of the three states that I have reviewed tonight, your signature places your fate in the hands of doctors. Your personal desires actually have no meaning at all, even though it seems so on the surface. Instead, signing a living will seems to be nothing more nor less than signing your life over to others so that they may not be held liable for what they do (or do not do) to you.
There is something disconcerting about the loud and unanimous call from nearly all pundits and news outlets that each and every one of us must go out right now and sign one of these. The effect will be to bring the Dutch Groningen Protocols to America, one patient at a time.
As for me, and for the time being, I would prefer to have no living will at all and make the doctors try to justify their unwillingness to continue treating me, instead of giving them a piece of paper that allows them to stop treatment whenever they want to do so. If it's about choice, these living wills are not the way to get there. I'm still a lawyer though, and I still have to make a living, so if you want one, I will draft yours for only $75. All I have to do is visit your state bar's website, print it out, and provide two witnesses. Easy money.