Living Wills Role in Health Care Administration

Living Wills Role in Health Care Administration

Living Wills Role in Health Care Administration

Introduction

A living will is a voluntary statement outlining the types and conditions of medical care that a person would prefer in a given situation prior to requiring care. A person may also nominate one or a number of substitute decision-makers (Power of Attorney) to make decisions of their own behalf. A living will sets out a consumer's wishes in relation to treatment decisions in advance. A living will may also cover financial, personal and medical decisions concurrently.

Analysis

Many people are unaware of living wills but seem highly interested once they hear about them. Elderly inpatients were confused by the term living will, but most would welcome the chance to discuss issues about facing the end-of-life, and many would want to limit their health care if they were critically ill. An assessment of the understanding of living wills some time ago found a similar state of affair. This juxtaposition of ignorance and interest raises an important question: what is this apparent appetite to discuss dying?

It is difficult to turn subjective phenomena such as a person's values and goals for care in a hypothetical situation into objective criteria. But psychometricians have set out a series of standards for the valid framing of topics and the elicitation and recording of opinions, wishes and reasoning. So, the living wills movement, which aimed to elicit preferences on how decisions should be made and by whom tried to apply these standard procedures. Moving away from the notion of a legal defense against aggressive doctors, the living will movement realized that it is the process that is the central issue. The main outcome was to honor the best available portrait of the patient's desires. A good process had to deal with several more things: the patients having a chance to consider and have some control over their last chapter of life; the proxy decision makers being ready for their roles; and the families having a chance to talk about issues relating to end-of-life and to resolve personal matters. Dying, it emerged, was a taboo topic that patients and families wanted to repossess. However, a number of studies show that living wills did not achieve their goal, and some commentators advocated dropping the whole idea (Smith, 1997).

A key assumption underlying the use of instructional advance directives is that the preference for life-sustaining treatment will remain stable over time and across changes in the individuals physical, psychological and social condition. If treatment preferences change substantially over time or with changes in an individuals life condition, then wishes stated months or years before an incapacitating illness may no longer reflect accurately the decisions that an individual would make for himself or herself if currently available. Although research on the stability of life-sustaining treatment preferences has been conducted; it has been conducted almost exclusively outside the field of psychology (McCormack 1998). Consequently, the studies the been primarily descriptive in nature with ...