In recent times there seems to be a renewed discussion about the benefits of a living will. While many people praise the living will most medical ethicists advise against them. A closer look at living wills makes it clear that while on paper a living will seems like a great idea in its practical application it is a nightmare that can lead to grave injustices. This short respnse will take a closer look at the ethical dilemma that is the living will.
A living will is a legal document that a person uses to make his or her wishes made clear with regards to end of life decisions. It attempts to make the autonomy and self determination of an individual available to the person when physically the person is no longer autonomous or self determining. As an official legal document the courts regard these instructions as the preferred basis for treatment.
While the idea of preserving personal autonomy for someone who no longer physically has it sounds appealing and ethical it simply is not practically possible. There are simply too many possible future situations that each person must try to imagine. Each of these future situations has their own set of burdens and benefits which cannot be truly predicted yet still must be weighed. A person who believes that by filling out a living will they are actually giving themselves personal autonomy in the future are only tricking themselves into believing a reality that does not exist.
The near infinite possibilities required by a living will make it impossible to have any sort of true informed consent. Informed consent means an agreement made in a particular case with a clear understanding of the current knowledge and well-understood facts. It is simply impossible to make an informed consent about a future event in which you do not have a clear understanding of all the possible facts. Those who are no longer competent to make their own medical decisions and need to rely on their living will cannot be making an informed consent because they can’t truly understand the choice available and do not have the knowledge available to make them.
In the case of a living will, a choice previously made by an individual is imposed on that person who is no longer able to change his or her mind. This inability of the patient to change his mind in light of the actual circumstances means the patient is not free; he cannot make an informed consent. While a person’s prior wishes should be respected, when a person can no longer make a free choice, caregivers, who are moral agents themselves, should do what is right for the person and not what a person wanted when they were not able to make an informed consent.
All people, while we may want to cling to our autonomy forever, must realize that dependency is a part of the normal course of human life. We should certainly discuss our wishes with our family, yet we should not trick ourselves into believing that we can make an informed choice about future circumstances in which we cannot have truly accurate knowledge about medical possibilities. We must come to accept that we cannot always have control over our lives and must realize that even the best made plans must be left to prudent caregivers who know the value of our lives and have the moral character to care for us even at the end of life.