The language of living wills
============================

* Thaddeus M. Pope, JD PhD

*   © 2008 Canadian Medical Association or its licensors

In a recent article in The Left Atrium, Mark Belletrutti and Ingrid DeKock present and highly recommend a living will from “Edward,” one of their patients.1 They write that “unlike many of today's legally prepared documents, Edward's document” gave real “insight into Edward's views on life, death, infirmity and the burden of illness on family.” It “portrayed his deep personal conviction on end-of-life issues.”

In fact, Edward's living will was professionally prepared. It was first published by distinguished bioethicists in *JAMA* nearly 25 years ago.2 Since then it has been widely reprinted as a “form” living will.3–5

Granted, just because Edward used a “form” living will does not mean that its language did not reflect his preferences for end-of-life treatment. However, the language of this living will does not clearly indicate what Edward's or any patient's preferences actually are. What physical disabilities trigger the refusal of treatment? What measures are considered heroic? It is unreasonable to expect Edward to have thought through all of the possibilities much less to have lucidly articulated preferences for every possible scenario. Consequently, perhaps it is time to abandon the living will and focus instead on the appointment of substitute decision-makers.6

## Footnotes

*   **Competing interests:** None declared.

## REFERENCES

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3.  3. Margolis HS. *Elder law forms manual: essential documents for representing the older client*. Frederick (MD): Aspen Publishers; 1999.
    
    

4.  4. Lerner J. *Financial planning for the utterly confused*. New York: McGraw-Hill; 1998.
    
    

5.  5. Smith GP. *Legal and healthcare ethics for the elderly*. Washington: Taylor & Francis; 1996.
    
    

6.  6. Fagerlin A, Schneider CE. Enough. The failure of the living will. Hastings Cent Rep 2004;34:30-42.
    
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