The Arguments Against a Living Will

Right-to-die (euthanasia) advocates believe that life reaches a point at which it no longer has meaning and that extra-ordinary life-sustaining methods should not be used.

The basic argument against the right-to-die concept is that human existence can never be intrinsically meaningless. Life retains meaning up until the last breath is drawn, and a physician is never entitled to deprive an incurably ill patient of the chance to "die his death." Studies have shown that most older people who have been hospitalized in intensive care units would be willing to undergo the life-sustaining treatment again, even if it would add only one more month to their lives. As one older person remarked, "Toward the end of life, even one month is very meaningful."

Before you write a living will, think carefully about limiting heroic measures to save your life as all living wills have limitations that you should understand. Anti-euthanasia people claim even the name is misleading: Living wills have little to do with living and a lot to do with dying. They claim they are not living wills at all but "death contracts." Some arguments to consider against writing a living will include:

• Living wills are written in general language since no one can anticipate all possible circumstances. This can lead to problems of interpretation. For example, your living will might prohibit "heroic procedures," but does not tell your doctor that you would refuse a respirator while accepting blood transfusions, or vice versa. As new technology develops and yesterday's heroic treatments become routine, the problem is even more complicated.

• The living will concept assumes that the patient or one that represents them understands the effectiveness and probabilities of success or failure of heroic life-sustaining measures.

• Medical need, in the context of constant technological innovation, is inherently elastic and open-ended: as a guide to what is actually good for the patient or what physicians are obliged to give them, is a judgement call.

• The prognosis of terminal illness is always difficult to achieve. This difficulty is part of the problem. In all too many cases, technology is used because it is not known that a patient is dying or in irreversible decline.

  The problem is even greater, a recent Office of Technology Assessment (OTA) study concluded, when immediate decisions must be made about initiating treatment. Only for patients who have been fully diagnosed can estimates of survival probability be made. Even then, the probabilities are likely to be insufficient for guiding decision making about withholding or withdrawing treatment for an individual patient.

• Some proponents of living wills maintain that these documents are necessary for cost and/or population control, and should be mandatory for certain groups including older people. For example, states like Oregon have legislated a "health rationing system" that eliminate procedures that are deemed too costly, ineffective, or rare. Some say the "need" to get rid of the aged has economic roots as the growing population is widely regarded as a threat to the nation's budget.

  In America, a number of "logical" proposals have already been made for rationing systems based on age. For instance, in Britain, anyone over age 55 may be denied kidney dialysis. In other words, the older one is, the less he's worth to social policy planners. Obviously, according to many, the older one is, the less effort should be expended toward life support.

  Some gerontologists contend there is a growing tendency in medical circles for age-based healthcare rationing. "Death with dignity" may in some cases be a euphemism for extermination.

  Studies show that emergency room personnel tend to spend less time and effort to resuscitate elderly heart-attack victims than their younger counterparts.

• If a physician is employed by an HMO (Health Maintenance Organization), or is a contractor to provide health, his or her own financial reimbursement and even professional position may be directly or indirectly dependent on the financial health of the organization--organizational well-being that potentially will be threatened by the high cost of prolonged sophisticated life-support technology.

Those in the anti-euthanasia movement are not suggesting that we as a society must use heroic, unnecessary, useless, or unduly burdensome measures to prolong life. They are opposed to a healthcare policy based on fiscal restraints rather than the needs of patients and the professional expertise of their physicians and a policy that requires healthcare providers to ensure that living wills are "implemented to the maximum extent permissible under state law." They are opposed to an attitude that sick or hopelessly ill people ought to sacrifice their lives by refusing medical treatment and care in order to make life easier for families or for America's future generations and to help balance the budget.