23 March 2005

Thy Will Be Done (Update)

From yesterday's Cox and Forkum:

Although that picture may be worth a thousand words, a few more are worth noting. Terri Cullen's "Fiscally Fit" column in today's Wall Street Journal (subscription required) and a related column, "Health Journal", published yesterday expand on a few points I discussed earlier.

When the option is available to you under local laws, it's advisable to prepare both a Living Will and a Durable Power of Attorney for Health Care. Ideally, this belt-and-suspenders approach will ensure, to the greatest extent possible, that your decisions and preferences concerning medical treatment are heard and given effect in the event you become incapacitated. It's not just years of legal training and experience which prompt me to throw those caveats into an otherwise reassuring sentence; if you shout (figuratively speaking) in your Living Will and your trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent designated health-care proxy shouts (perhaps literally) when you are no longer able to, the shoutees still may not listen right away or at all.

From "Health Journal":
Some doctors say living wills are only a good start. They can't cover all of the potential what-ifs and medical gray areas that can arise. Also, some recent research shows that doctors won't follow them to the letter. In a study published last year in the Archives of Internal Medicine, doctors were asked to consider six hypothetical medical cases. Overall, 65% of the decisions the doctors made were contrary to patients' advance directives.

"Living wills don't reflect the complexity of the decisions," says Nancy N. Dubler, director of the division of bioethics at Montefiore Medical Center in New York.

. . . .

Doctors say the more important decision, however, is creating a health-care-proxy or power-of-attorney document.

From "Fiscally Fit":

While living wills detail the type of medical care individuals want in the event they become incapacitated or are near death, it doesn't guarantee that a patient's wishes will be followed. It's not uncommon for family members -- or doctors -- to disagree on the appropriate course of action, which may go against the guidelines in an advance directive.

Among the factors that are taken into consideration when deciding on whether to abide by a patient's stated wishes are the prognosis and quality of life, as well as the wishes of family or friends, according to a study from the Loma Linda University Medical Center, in Loma Linda, Calif. "Advance directives are used in decision making, but in practice probably not as absolutely as the document might imply," says Steve Hardin, an assistant professor of medicine who oversaw the study.

As a result, families can find themselves battling health-care providers, or each other, amid already devastating emotional anguish.

So where does all this leave us? Essentially, these documents are about making clear decisions, expressing those decisions clearly, and tapping someone you trust to do his or her level best to see things through. These are not guarantees, but these documents greatly improve your odds of getting your way in the last argument you'll ever have.

Law schools teach their students never to think in absolutes -- only tortured analogies and ridiculous hypotheticals can possibly capture the scope and grandeur of the human experience. Here's an analogy offered in an attempt to sum this all up: your health-care proxy is Roy Hobbs and your Living Will is "Wonderboy". "Wonderboy" is a fine bat even without Roy; any solid player could pick it up and hit with it. Roy would still be "The Natural" even without "Wonderboy", but with it, he's even better. I know, I know -- even after "Wonderboy" was firewood and that dumpy batboy brought him a different bat, Roy hit a home run. Still, if that final swing were a matter of life and death for you, you'd want Health-Care Proxy to hit with Living Will, wouldn't you?

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