Welcome to Living Will Advance Directive. Our mission is to provide information and materials to all persons intent on planning a more secure future. Our vision is that every person has the information he and she needs to put the best possible plan in place to protect themselves and their families against unexpected and severe medical circumstances in which one loses the capacity to make medical decisions on one’s own behalf.
We live in a world in which medical technology can, within certain limits, bring a dead body back to life. We see this all the time on television hospital dramas and police procedurals. Someone goes into cardiac arrest and stops breathing. “Code Blue” is called and hospital staff rushes in with a crash cart. Or EMTs arrive at a restaurant, public park, or accident site and begin CPR. In almost all cases (depending on the script) the victim miraculously regains consciousness and soon thereafter is healthy and well. We are led to believe that such remarkable outcomes are the norm in the real world. They most emphatically are not.
Many in the bioethics community question the assumption that CPR is generally beneficial and should be withheld only by exception. In fact, nearly 44% of survivors of in-hospital CPR have a significant decline in functional status.1 Further, approximately 15% of survivors of resuscitation attempts suffer substantial brain damage.2 Bringing a person back to life via CPR frequently results in many years of severe debility associated with a substandard or poor quality of life. Many of us would prefer not to survive under such conditions.
Stuff happens. No one can predict the future. We can, however, make reasonable plans to protect ourselves, our families, and our assets. Writing a living will is part of that planning. In the absence of such a document, emergency responders and medical professionals will take all available actions to resuscitate a person whose heart has stopped or to revive an unconscious person. There are many circumstances in which a person may not wish to have heroic measures performed to restore life or otherwise intervene in natural processes. But without specific instructions, one’s preferences and desires in end-of-life conditions will not be honored.
Beyond writing a living will, it is also critically important to express your preferences to family members and close friends. These may not be particularly pleasant conversations and they’re not conversations that most us of would readily initiate and undertake. But they are necessary if one’s desires and preferences are to be upheld when one is not able to speak on his or her own behalf.
1Burns JP, et al: Do-not-resuscitate order after 25 years. Crit Care Med 31(5):1543-1550, 2003
2Freeman JM, McDonnell K: Tough Decisions. Cases in Medical Ethics, 2nd ed. New York, Oxford University Press, 2001, p 7