I talked in a prior post about how someone might be named a surrogate decision maker, or power of attorney for health care decisions [POAHC] for another person. I had planned the next post to be about the job of being a decision maker, and I’ll get to that. However, even though this is a sign that the chances of this being a finite series of posts are not great, I have already come to a tangent I want to pursue. [I can hear current and former students saying, “Yup, a tangent. Here we go!” Hush, all y’all.]
This particular tangent came from looking at the forms that several different states use for naming POAHCs. Most of these forms include some variation of a declaration called a Living Will, which allows you to make certain decisions about treatment at the end of life. They allow you to choose whether you want aggressive treatments if you are irreversibly comatose or terminally ill, for some states whether you want artificial nutrition and hydration, and some allow for more instructions. Louisiana’s, for example, has a full blank page included for any additional instructions.
Who should fill out a form like this? The simple answer is, pretty much everyone over the age of 18 should. The reason for this comes partly from the way that the US developed statutes for living wills and advance directives. Living Wills were known at least as far back as the 60s, when Cecily Saunders and the relatively new hospice movement made end of life care development a legitimate area of conversation. But they didn’t get adopted in lots of states from that.
No, we can track much of the discussion of living wills in legislatures to several highly publicized medical cases that got national public attention as well as political attention. The three cases that probably impacted laws and practices about advance care planning the most were those of Karen Ann Quinlan, Nancy Beth Cruzan, and Terri Schiavo.
There are deep online dives possible for each of these cases, so I won’t go into many details. The Quinlan case was early, and set some significant precedents about end-of-life decision making. The Cruzan case went to the Supreme Court, which declared among other things that surrogates can refuse even nutrition and hydration if that’s what a patient would have wanted, but also that states can set a very high bar for proof that this is what a patient wanted. In part from these two cases, many states developed laws allowing persons to choose to refuse treatments for someone for whom they were the surrogate decision maker, laws allowing persons to choose who their decisionmaker would be, and living wills to assist in guiding those decisions. The Schiavo case was seen by some as a chance to reverse some of those decisions; the US Supreme Court declined to weigh in and state laws stayed in place.
So what? Well, consider: All three were young women who were in what we would now diagnose as a persistent vegetative state. Because they were young and otherwise healthy, they lived a long time on life support and Cruzan and Schiavo could possibly have lived much longer. None of them had named decision makers or had written guidance about their choices. Their cases and their lives in a vegetative state dragged on for a long time, and they became political footballs. If you don’t want that, you want to make sure your wishes are known.
So who needs an advance directive? People who are ill and close to death? Sure; you want to have your wishes followed in those circumstances. But young people who are healthy and might live a long time without their wishes being followed? Them too. So who needs advance directives? Pretty much everyone over the age of 18 should have one, or at least should have a conversation with the persons who would end up making decisions for them.
But that’s a hard conversation to have. Fortunately, there are some tools available to help guide those decisions. In the next post in this series, unless I go on another tangent, I’ll talk about some of these tools.
#AdvanceDirectives #generalpublic #tangent #series
