The concept of a living will is one major bioethics issue that has continuously aroused heated public debates. The responsibility of doctors to safeguard human life has always been in constant collision with individual rights to consent Doctors have to contend with administering assisted suicide in cases where the patient directive states .However is selected medical conditions withdrawal of treatment can lead to very painful death.
Advanced medical directive or living will is a legally binding document that stipulates specific directions on life and death decisions in the event that one is incapacitated by critical or terminal illness and is in a state of permanent unconsciousness where there is clearly minimal or absolutely no chance of recovery. In such a situation, the patient is rendered legally incompetent in deciding whether an artificial means can be used to prolong his or her death and therefore after a physician makes a written diagnosis on the medical condition and a second physician examines the patient and confirms the patient’s in a written diagnosis, an appropriate decision is taken. Such a directive may stipulate whether an individual can be subjected to a life sustaining medication, when such medication can be initiated , when it can be continued, when it can be withheld or even withdrawn in the event that they cannot make the consent. Living wills protect an individual’s right to make medical choices irrespective of the health status. This saves the family from making painful and difficult decisions. In other cases, a person appointed by the individual to make health decisions on his or her behalf retains the right to consent.
The Federal Patient and Self Determination Act (1990) direct that all healthcare providers should ensure that at admission, the patients should attest whether they possess an advance health declaration.
There are various state laws that contain specific directions on living wills. Pennsylvania Advance Directive for Health Care Act provides an acceptance of the desire of an individual to withhold or even withdraw medical treatment. Such acts are therefore not considered by law as suicide, homicide or euthanasia. New Jersey Advance Directives for Health Care Act; 1991, recognizes and promotes the use of advanced health directives in line with the federal guidelines (www.pabar.org).
Different states have varying laws for confirmation and identification of individuals with advance directives. One of the challenges involved in the documentation is a situation where an advanced health directive contains both care instructions i.e. a living will, and the presence of a health care agent designated to consent. The clinician is thus placed into a situation where there cannot be an effective implementation of the directive (www.rwjhamilton.org).
The variant legal languages used in advance directives by attorneys who are unfamiliar with the effects of their drafts in a clinical setting remain a key hindrance in the implementation of advanced directives. The federal, state and healthcare providers should advocate for standardized advance health directive documentation. The Self Determination Act passed by congress in 1990, required healthcare providers to provide conclusive information to adult patients on their rights as regards to medication and advance directive. In 1998, Minnesota signed into law several other directives and passed that several other directives from other states are only legal if they are in agreement with Minnesota requirements.
Patients guide; Advance Directives (Living Wills) Retrieved Sept 18, 2008
Advanced Health Care Declaration. Retrieved Sept 18, 2008