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By Dr Peggy Norris, Chairman of ALERT, Against Legalised Euthanasia - Research and Teaching

A CASE AGAINST THE LIVING WILL

The words "Living Will" would appear to be a contradiction in terms, as Wills are normally associated with administering the estate of a person who has died. The law is particularly careful to ensure a Will is valid, i.e. that no undue pressure was brought to bear on the testator, and only then is probate granted and the deceased person's wishes carried out. Living Wills or Advance Directives, on the other hand, are designed to be implemented while a person is still alive but unable to communicate his/her wishes to the attending doctor, and no one is required to check whether the patient was fully informed of the consequences of signing.

THE BALANCE OF POWER

Wesley J. Smith, a U.S. consumer advocate, author of "The Senior Citizen's Handbook": noted in the Wall Street journal on May 4th 1994 that the Living Will "changes the balance of power." "Once a Living Will is signed, the patient gives up the protections of informed consent, leaving all health care decisions in the hands of the medical profession. The power to decide whether the time has come for the Living Will to go into effect belongs to the doctor, as does the power to decide the type and extent of medical intervention that is to be withheld. And this power is not restricted to 'extraordinary care,' such as ventilators to assist with breathing, but to any medical intervention - from not treating a curable bacterial infection to withdrawing food and fluids so that the patient starves and dehydrates to death."

The patient is no longer in control, yet the assumption on which people are invited and indeed encouraged to sign is that such a document ensures the signer's autonomy. The reverse is the case. The purpose it serves is twofold. When a patient cannot communicate it enables a doctor to hasten death whilst prohibiting him or her from using any clinical expertise to try to restore health or well-being. At the same time it absolves the doctor from legal responsibility for the patient's premature death.

EUTHANASIA

The idea was launched in the U.S.A. in 1969 by a law journal article entitled "Due Process of Euthanasia: the Living Will, a Proposal." (In Britain the Voluntary Euthanasia Society is the main distributor of Wills/Directives). The proposal soon found favour with U.S. government officials as an economy measure. The leaked "Derzon memorandum" advised President Carter to "Change social values regarding cost-inducing activities" and stated "The cost-saving from a nation-wide push toward 'Living Wills' is likely to be enormous. Over one-fifth of Medicare expenditures are for persons in their last year of life." But it was not until 1991 that it was made compulsory for all patients admitted to hospital in the U.S., for whatever reason, to be presented with "Living Will" forms.

In Britain's hard-up Health Service, there is little danger of incompetent patients being expensively over-treated and forbidden to die, supposing that could be done. To guard against "officious" treatment, members of the public should not have to sign their lives away. Instead the public should insist that doctors uphold professional standards of care.

MISINTERPRETATION

Can Living Wills be misinterpreted? I quote Wesley Smith again:

"There is a growing body of evidence that living wills are being misapplied so as to deny care to people with treatable medical conditions. For example, there is the tragic case of the 73-year-old woman in the Midwest who, upon entering a hospital for hip replacement surgery was given a living will to sign along with other admission forms. She tolerated the surgery well and was on the road to recovery. Then, she suffered a cardiac arrest.

"Rather than attempt to save her (remember, the woman was not otherwise terminally ill), it was assumed that because she had signed a living will she wanted to die if faced with a grave medical condition. Thus, the woman was given no medical assistance whatsoever and died - a process that took some 20 minutes. The woman's daughter was not even notified of the problem nor asked for permission to 'do nothing.' The first the daughter found out about the crisis was when she was informed of her mother's passing."

Lord McColl, a senior surgeon at Guy's Hospital, said in the House of Lords debate on May 9th on the Report of the Select Committee on Medical Ethics:

"I have some anxiety over directives produced by the Voluntary Euthanasia Society which contain in them a refusal to take food and water by so-called artificial means. If such directives are legally binding upon a doctor, then we may see cases in hospital of patients dying through lack of food and water, perhaps patients with P.V.S., motor neurone disease or Alzheimer's ... advance directives could become the back door for euthanasia, for some would consider it more humane to kill than allow patients to die through lack of food or water" .

POWER TO THE PAST

An Advance Directive gives power to the past. It sets the young person you once were, with an instinctive horror of old age and disability, against the old person you become, and makes the earlier judgement binding on you.

Doctor magazine on 2nd December 1993 reported: "A study by the Imperial Cancer Research Fund three years ago showed that more than one in two cancer patients would accept any drug treatment, no matter how severe the side effects, if there was even a one per cent chance of cure. But this enthusiasm was not shared by a matched sample of healthy patients. Only one in five of these said they would subject themselves to toxic treatments." At least cancer patients would be able to tear up their Living Wills. Victims of stroke or cardiac arrest would not.

The Euthanasia movement has done a brilliant job in persuading unwary people to sign orders for their own future deaths, which must be carried out, whether their own doctor is willing or no, when they can no longer countermand them. The ideal of physical perfection is served by Living Wills; but that of a humane society is not.

Published in "EAGLE" Aug/Sept 1994, and reproduced with permission.

Note by ALERT 1997; Fightback by some doctors has now made it less certain that Living Wills are legally binding, when it is obvious that the patient did not clearly foresee his present condition. They are still dangerous.