DO HEALTH PROVIDERS HAVE LIVING WILLS?
Dr. Christine Castle. Medical Ethicist and Chief of Internal Medicine at the University
of Chicago Medical Center observes that although 44 states recognize living wills,
few people exercise their option to prepare advance directives. This is true, even
among health care providers. Dr. Castle remarks that in any given audience of
doctors and nurses that she addresses, invariably no more than ten percent raise
their hand when asked it they have a living will. She concludes from this telling fact
that "there is something fundamentally human about not wanting to think about one's
own death."9
PATIENT SELF-DETERMINATION ACT of 1991
Currently, only 5 to 10 percent of all adults have advance directives. The Patient
Self-Determination Act of 1991 encourages more patients to think ahead by requiring
every hospital, hospice, nursing home, and health-maintenance organization
participating in Medicare and Medicaid to inform patients of their right to decide how
they want to live or die should they become gravely ill. Each state has to develop its
own laws on advance directives. Each hospital, in turn, has to make that information
available to its patients upon admission. At the present time, medical treatment
facilities are not covered, however, this does not preclude a future requirement for
them to comply with these guidelines. 10
e. Deduced From Religious Beliefs. An oral directive might play a role for
patients expressing opposition to treatment on religious grounds. The refusal of care
could be deduced from the patient's statements of religious beliefs, provided these
beliefs were sincerely held and practiced while the patient was competent. (On the
other hand, religious beliefs might not play a role. An individual might not agree with all
of the teachings of his or her own faith. Some Jehovah's Witnesses, for example, will
accept a blood transfusion if convinced they would die without one.)
f. Condition, Prognosis, and Nature of the Treatment. Generally, if the
patient's condition is extremely grave, some courts have permitted refusal of any type of
treatment.
g. Risk-Benefit Analysis. If there is no knowledge of what the patient's wishes
were, as in the case of a never-competent patient, a risk-benefit analysis will have a
greater role to play in arriving at a treatment decision. (A risk-benefit analysis may also
be helpful to parents trying to make a decision regarding treatment for a minor.)
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