Leadership for Public Education

What is in YOUR Living Will?

Or, more importantly, do you have one? Studies of health care workers have found that a surprisingly large group of individuals have not executed a Living Will or any type of Advanced Directive for health care. When questioned as to why, the answers tend to mirror responses given when asked if they have a Last Will and Testament - "I haven’t gotten around to it," or "I'm too young for that" rank as high responses, even among respondents in their 60s.

Nurses are often faced with frequent, if not daily, reminders of the need for such documents - the issue of whether a patient should be resuscitated, in all unique types of clinical situations, can present a dilemma for the bedside nurse. Every nurse remembers the first time they are with a patient who needs to be resuscitated and it is their responsibility to "call a code." Fortunately, in the usual clinical situations where this occurs, the indications are clear as to when a code should be initiated. Some cases are exceptions, which can present a problem and those are always memorable.

As Standards of Care have evolved and society has become more aware of these issues, a consensus has emerged on a number of clinical situations where it is appropriate, based upon the physician’s medical judgment, to issue a "do not resuscitate" order for hospital nurses to follow. For example, a patient with terminal cancer who is receiving only comfort measures will usually have such an order. 

More complex cases, such as the Terry Schiavo case in Florida, present greater challenges. Clinical interventions, such as the insertion or continuation of feeding tubes, often are not as clear cut. It is particularly difficult if the patient is unable to speak for themselves. In Terry Schiavo ’s case, her husband and parents presented conflicting information as to what she would want to have done in that clinical situation.

If the patient is a competent adult who is able to speak for themselves and can understand the consequences of their decisions, the health care providers can communicate directly with the patient regarding difficult decisions. The majority of difficult cases occur because the patient is unable to communicate and the next-of-kin do not know or have conflicting points of view as to what the patient would wish to have done. Conflict among the next-of-kin in these difficult situations makes it especially challenging for the health care providers. The importance of a written document providing such guidance cannot be overestimated. 

The content of this article does not constitute legal advice and is not intended to be a substitute for legal advice regarding the particulars of your case and your rights and obligations under law, regulations, and/or labor agreement.