Sunday, January 15, 2006

living wills (right-to-die laws)

A living will is a directive made by competent adults to ensure that if they become terminally ill "heroic" means will not be employed to prolong their life. At press time, thirty-eight states and the District of Columbia have passed statutes known as "right-to-die" laws or natural death acts.
These laws place some limitations on binding advance directives. Under most statutes these directives only become operative if a consulting physician agrees that the patient is terminally ill. Some states even require the patient to reconfirm his or her wishes after the onset of the terminal illness. The interpretation of "heroic" and the real intentions of the terminally ill patient are often open to debate. Therefore, many patients choose to delegate to a particular person the legal authority to enact their healthcare wishes if they should become incompetent. Several states even require such delegation. The remaining states have durable power of attorney statutes that are generally broad enough to authorize someone to make health-care decisions.
Advance directives are clearly the preferred choice rather than have the court appoint a guardian to speak for the patient, which is the customary practice if there is no advance directive. However, in recent years, five states have authorized families of adult patients to make decisions on their health care without going to court and 12 other states have similar statutes.
These new statutes vary in many respects but all address five areas of concern:
1. The type of patient eligible
2. The type of treatment that may be withdrawn or withheld
3. Which family members can exercise authority
4. Measures to prevent abuse of power by family members
5. Provisions for physicians to make decisions for the patient
Areen, J. The Legal Status of Consent Obtained from Families of Adult Patients to Withhold or Withdraw Treatment. JAMA. Vol. 258: 229- 235 (1987).

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