When you think of living wills–if you think of them at all–under what scenario do you envision them being needed?  Terri Shaivo, right?  Brain Death. Vegetable. Living wills are often structured around “If there is no hope of my recovery, or “If I have an incurable disease”, or “If I’m brain dead”, but what if your mind is fine and it’s your lungs that don’t work, and most likely won’t ever work?  What if there is a chance of you recovering, but the chance is extremely slim and if you survived you would mostly likely spend the rest of your so-called life on a ventilator flat on your back in a nursing home?  A Living Will cannot cover every scenario–and even if it covers a laundry list of what ifs, it will most likely be ignored by medical professionals anyway, because of America’s prevalent culture of “we must do everything even if they don’t want it so I don’t get my ass sued later” 

The medical profession in this country is poorly (if at all) trained to deal with end-of-life issues, specifically not only the potential for quality of life, but quality of death; as I’ve recently learned during the horrific 9 weeks my stepfather was in the Intensive Care Unit of an Arizona hospital, and from reading a most helpful book: Last Rights: Rescuing the end of life from the medical system by Stephen P. Kiernan.

The only reason my stepfather’s living will wasn’t ignored–and it would have been–is that he had the foresight to appoint my mother his medical power of attorney. If he had not done that–if there was no one there to fight for his right to die pain free, with peace, and with dignity–one of his doctors would have kept him “alive” until he died after much suffering, or survived to spend the rest of his life in a state he would never, ever want.  According to a study cited in Last Rights, conflicts between doctors and families in ICUs are extremely common, and that was certainly our experience, although only with one doctor.  This doctor who, for whatever reason–personal, religious, don’t sue my ass–refused to be realistic with my family, insisting that there was a chance my stepfather could recover, making my mother feel like she was killing her husband by not grasping for a 1 in a million chance that my 76 year old stepfather might be half the person he was.

To be fair to this hospital, the nurses were all outstanding, every one of them was honest, realistic, and direct with my family.  When asked about the one doctor they all said “yeah, he never, ever gives up”.  While not giving up may be viewed as a virtue by a medical training system only seeing things in terms of black and white, failure or success, life or death, in practice doctors should be trained to consider the odds.  Sure a patient could recover, people do; I could also win the lottery, people do: but the odds are 300 million to 1.