back off! i'm not dead yet....oct 14, 2007 · schiavo exercise her "right to die"...

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BACK OFF! I'M NOT DEAD YET. I Don't Want a Living Will. Why Should I?

By Charlotte Allen Sunday, October 14, 2007; Page B01

Do I have to have a living will? Last year, I had an experience that gave me the distinct impression that if I didn't have one, my life was hardly worth, well, living.

A routine mammogram had revealed that I had early-stage breast cancer. This kind of cancer is noninvasive and thus not particularly life-threatening if promptly attended to, and the required outpatient surgery isn't especially risky. Nonetheless, one of the shoals I had to maneuver through at the hospital (which otherwise afforded me excellent care) was a series of efforts to persuade me to sign on to the currently fashionable notion of a "good death."

Those efforts came in the form of a living will, one of those advance directives on end-of-life care that are currently urged upon us all by such high-minded organizations as the American Medical Association, the American Bar Association, state laws and an array of policymakers, bioethicists and advice columnists. Even this newspaper ran a long article in its business section this year advancing the notion that you haven't got your life in order without a living will. Whether to have a living will is presumably up to the patient. But I've developed a sneaking suspicion that someone else may be hoping to call the shots. After three attempts to induce me either to sign up or to state my refusal to do so in writing, I had to wonder how voluntary a living will really is in many cases. In my case, I started to feel ever-so-slightly harassed.

When I showed up at the hospital for some pre-surgery medical tests, one of the receptionist's first questions was, "Do you have a living will?" The form she gave me after I shook my head was as complicated as a tax return. There were numerous boxes for me to check specifying a range of conditions under which I might like to have a Do Not Resuscitate order hung over my hospital bed, whether I would want to be denied "artificial" food and water under some circumstances, what I thought about being taken off a ventilator, and so forth.

Furthermore, I found something weasely in the way all those options were presented, as though my only real choice were between being dispatched into the hereafter at the first sign of loss of consciousness or being stuck with as many tubes as needles in a voodoo doll and imprisoned inside a ventilator until global warming melts the ice caps and the hospital washes out to sea. I found the box on the form that said "I decline a living will" and checked it. Right now, my husband is my living will, and after we spent 13 days observing Terri Schiavo exercise her "right to die" by being slowly dehydrated to death after her feeding tube was removed in 2005, he knows exactly how I feel about such matters.

A few days later, when I returned to the hospital for the surgery, a different receptionist handed me a second living will. "I've already gone through this," I said, handing it back. After the operation, I was back to begin six weeks of daily radiation. A third receptionist pulled out the very same form and asked the very same question: "Do you have a living will?" At least I knew where to find the "I decline" box fast.

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of 24BACK OFF! I'M NOT DEAD YET. - washingtonpost.com

10/22/2007Page 1 of 24http://www.washingtonpost.com/wp-dyn/content/article/2007/10/12/AR2007101201882.html

Now, I'm sure that all three receptionists were just doing their jobs. A 1991 federal law requires hospitals and other health-care facilities to make their patients aware of living wills. Yet the repeated experience of being given 30 seconds in a busy lobby to read and sign a complex document that cast a negative pall upon positive efforts to keep me alive did not inspire my confidence in the living-will industry.

In fact, when I contemplate the concept of "dying well," I can't avoid the uneasy feeling that it actually means "dying when we, the intellectual elite, think it is appropriate for you to die." Consider what's happened in recent years: The classic Hippocratic Oath and its prohibition against physicians giving people a "deadly drug" has collapsed with the growing acceptance of such notions as physician-assisted suicide, the "right to die," and even giving some very sick, disabled or demented people a little push over the edge, as seems to be the case in the Netherlands. People facing end-of-life decisions may well feel subtle pressure from the medical and bioethical establishments to make the choice that will save the most money, as well as spare their relatives and society at large the burden of their continued existence. A "good death" -- that's the English translation of the Greek word that begins with an "e." You know, euthanasia.

Even the hospice movement, which has historically opposed anything that smacked of euthanasia, has become tainted by this thinking. Hospices and home hospice care had always sounded wonderful to me: providing a comfortable place for the hopelessly ill to die with sufficient pain medication and no burdensome and futile efforts to prolong their lives.

Then, seven years ago, I paid what I thought would be a last visit to my 93-year-old father, who was dying of prostate cancer at home with round-the-clock nursing care. The phone rang, and I picked it up. On the other end, a middle-aged male voice inquired about my dad's condition. "Sooner or later he's going to go into a coma," said the voice, which never got around to identifying its owner but was presumably a friend of my parents'. "Then, what you have to do is take him to a hospice. That's what we did with my mother. They'll put him on a morphine drip, and he'll be gone in a few days. They know what to do." I was too dumbfounded to ask the obvious question: Why would someone in a coma need morphine? (My father, by the way, died at home some five months after that visit.)

Certainly not all hospices engage in practices that deliberately hasten death. But in February the American Academy of Hospice and Palliative Medicine reversed its long-standing opposition to physician-assisted suicide (which is legal in Oregon and said to be quietly practiced by many doctors elsewhere) and adopted a new set of rules that effectively endorsed the practice. The academy even decided on a new euphemism for the procedure: "physician-assisted death." Even where assisted suicide is illegal, many hospices now endorse "terminal sedation," the ethically murky practice of anesthetizing terminal patients, then cutting off their nutrition and liquids.

The problem is that nowadays there is simply no societal agreement on how people who are sick or disabled beyond hope of cure ought to be treated. Many people, especially highly educated, nonreligious people, think that "physician-assisted death" is exactly the right way to go -- or to send off your unconscious mother. If you think that bioethicists will erect safeguards against this sort of thing, think again.

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Related Back Off on Hospice Care Charlotte Allen set back our nation's already inadequate knowledge of hospice care and end-of-life issues with her grossly inaccurate article, "Back Off! I'm Not Dead Yet," in Sunday's Outlook section.

More on washingtonpost.com Outlook: Death to the Living Will: The Year's Must-Have Document Offers Patients Little Gray Area in Life-or-Death Decisions The Mukasey Hearing Free Range on Food: Dish With the Experts The Reliable Source

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10/22/2007Page 2 of 24http://www.washingtonpost.com/wp-dyn/content/article/2007/10/12/AR2007101201882.html


BACK OFF! I'M NOT DEAD YET.

As far as I can tell, bioethicists exist for the most part to do some moral chin-pulling before giving the green light to whatever consensus the rest of the elite have reached. If you believe, as the Dutch do, that it's fine for a children's hospital to euthanize severely disabled infants, you can always find a bioethicist to give you a stamp of approval. If you want to harvest the organs of dying people without waiting for brain death to occur, you can probably find a bioethicist to sign on to that, too. Myself, I'm with Slate blogger Mickey Kaus. In 2003, as the Schiavo controversy was raging and Yale surgeon Sherwin Nuland, author of "How We Die" and an advocate of limited assisted suicide, was pontificating on National Public Radio about her low quality of life, Kaus wrote: "If I'm ever in Terri Schiavo's situation, and not in any pain, please follow these simple steps: Keep the feeding tube in, and keep Dr. Nuland out."

It's not surprising that many people have reservations about theories of "dying well" that always seem to involve not staying alive. In 2004, the Hastings Center Report, a journal that focuses on bioethics, reported that despite decades of aggressive promotion of living wills, only 18 percent of Americans of all races had them, including only 35 percent of residents of nursing homes. Those most suspicious of the talk about "dying well" are African Americans and members of other minority groups. African Americans are only one-third as likely as whites to have a living will, and only one-fifth as many blacks as whites sign DNR orders.

According to the article's authors, it seems that people talk a good game about living wills, especially when they're healthy, but when their health begins to fail, they often have very different ideas about what they would be willing to undergo to stave off death for a little while. Furthermore, according to a 1990s study by the National Institutes of Health, even when patients have living wills, if those wills contain directives with which doctors and hospitals disagree (such as, I myself suspect, prolonging the patient's life instead of terminating it), many doctors simply ignore the patient's desires. Living wills, it would seem, are effective only if they happen to comport with doctors' and bioethicists' own theories about what is best for the patient anyway. For this reason, the authors of the Hastings study propose that instead of filling out a living will, people execute a durable power of attorney, a simple document that entrusts decisions about end-of-life care to a relative or friend who shares the signer's moral beliefs about death and dying. That sounds about right to me.

A year ago, I received the gentlest of shoulder-taps from the man with the bony fingers, though he'll inevitably be back. I wish we lived in a different kind of society, one with agreed ideas about what a "good death" means -- but we don't, at least not now. So I say: Go ahead and sign a living will if you want. Have your doctor pull out your feeding tube or inject you with cyanide or do whatever fulfills your idea of death with dignity. But count me out. I don't want to "die well"; I just want to die in peace.

[email protected]

Charlotte F. Allen is the author of "The Human Christ:

The Search for the Historical Jesus."

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10/22/2007Page 3 of 24http://www.washingtonpost.com/wp-dyn/content/article/2007/10/12/AR2007101201882_2.html


Your Comments On... BACK OFF! I'M NOT DEAD YET. Do I have to have a living will? Last year, I had an experience that gave me the distinct impression that if I didn't have one, my life was hardly worth, well, living. - By Charlotte Allen

irae wrote: I'd like to join in the chorus of 'ignorant nonsense spewed soley for the furtherance of a right-wing religious agenda'. I'm shocked, SHOCKED that such a mindless righty screed would show up in the WaPost editorial pages. Shocked... 10/15/2007 2:22:17 PM

johnnormansp wrote: What a wierd qestion that is in the by-line "Why do I need a living will?" You might ask, why do you need a normal will? Simply so that people will know what you want done. The only difference is that a living will applies to cases when you are incompacitated/unconscious, but not dead. 10/15/2007 2:11:09 PM

skbjagoldman wrote: The living will states your preferences and wishes under certain, often life threatening or end-of-life circumstances. Physicians may make recommendations but the decisions are patient and family centered. If your preferences are for "everything for as long as my heart continues to beat", the living will can state this. To avoid the discussion for the reasons stated in the op-ed is to make a decision by no decision. It's never pleasant to contemplate these difficult issues and even less so at a time of crisis when the burden falls to distraught loved-ones who often wonder what the patient would want done. Take a peek from under the sand where your head seems to be. Being human, we must begin to face the "catastrophe waiting in the wings." 10/15/2007 2:02:28 PM

howlless wrote: This op-ed is so badly written, even the title contradicts its premise. "I'm Not Dead Yet"? Well, that's sort of the point of the living will, now isn't it? When you ARE dead, there isn't an issue. It's when you're not dead YET that all the drama starts. 10/15/2007 1:38:36 PM

elroy1 wrote: All you have to do is check "no," you moron. 10/15/2007 12:46:36 PM

dn1021 wrote: Charlotte F. Allen's article is more of a rant than a well-thought-out argument. MANY people posting comments have raised real issues, such as what if she and her husband are both injured in an accident, or what if her husband and other family members don't agree on what her wishes would be? Many have pointed out that Terri Schiavo's situation is exactly OPPOSITE to how Ms. Allen portrays it. It would be nice if Ms. Allen would read the comments and write another more thoughtful article. 10/15/2007 12:41:30 PM

smeesq wrote: stan1 wrote: it is because of liberals like john edwards suing dr's & hospitals and putting them out of business is why insurance is so high and health care is so lousy. thank you liberals ____________ Just curious...can you provide the name/citation of ANY lawsuit John Edwards ever filed against a hospital/doctor/medical provider? I think not. He sued large corporations, usually on behalf of plaintiffs that had been horribly injured by the company's negligence in manufacturing defective products. 10/15/2007 12:40:36 PM

dn1021 wrote: stan1 says "it is because of liberals like john edwards suing dr's & hospitals and putting them out of business is why insurance is so high and health care is so lousy. thank you liberals" stan1, that doesn't even make sense and is completely out of context to this discussion. 10/15/2007 12:37:21 PM

smeesq wrote: Thge 1991 law and the push by hospitals to get patients to sign living wills is done largely to end the terrible waste of medical resources devoted to doing "everything possible" to save 92 year old demented, terminally ill patients, who would NEVER have wanted those heroics had they had a chance to express their preferences while still of sound mind. Families of such similarly debilitated patients who insist that their loved ones receive every medical intervention "humanly possible" should be required to pay for those costs after a physician deems the patient terminal. Few families would mortgage their homes to extend the life of a dying parent for a couple of pain filled days in the ICU. 10/15/2007 12:36:28 PM

jp1954 wrote: Ms. Allen is apparently happy that hospitals are dragged into pointless lawsuits between warring family members who can't or won't agree on how to care for their loved one who can no longer give consent. The costs of these lawsuits are eventually borne by everyone else. Quit being a freeloader, Ms. Allen (and that goes the same for the rest of the anti-medical-directive crowd posting here). 10/15/2007 11:32:34 AM

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stan1 wrote: it is because of liberals like john edwards suing dr's & hospitals and putting them out of business is why insurance is so high and health care is so lousy. thank you liberals 10/15/2007 11:24:10 AM

gwatts wrote: Did this woman do any research at all before writing this? Perhaps she should have actually read what is in Living Wills, Medical Directives, etc. instead of guessing. Incredibly ignorant drivel. 10/15/2007 11:20:42 AM

Meach wrote: I'm a paramedic in a metropolitan area. I can't tell you the number of times that I've had to try to resuscitate end-stage cancer patients and nursing home patients who have had a debilitating stroke, but whose family had no directions and consequently have insisted that "All Measures" be taken. Working on a 94-year-old with a gastric feeding tube, a urinary catheter and whose main excitment in life is being rolled over a couple of times a day is very depressing. "Go gently into that good night" is a very good thing and, as we so often forget, natural. Sometimes, bad things happen during "routine" procedures. The time to have your say about the care you want is before that happens, because afterward may be too late! I have a living will and strongly encourage my patients and their loved ones to plan ahead and not to try to guess when the doctor is standing at the bedside. It also saves family conflict. no one can doubt what care you do or don't want, if you say it yourself! 10/15/2007 11:12:21 AM

burntnorton wrote: Folks, you likely don't need a lawyer to do an AD or Durable Power for Attorney for Health Care Decisions (or whatever your state calls it). Most states have a form, provided by the state health department or Attorney General, that you can fill out for free. IF it needs to be notarized, most banks will also do so for free. Contact your state government, the AARP, or your doctor to find out where to get a copy, fill it out with whatever your preferences are, and give copies to your primary care provider and your close friends/family members. Don't let misinformation and artificial barriers stop you. It really is the most loving and responsible thing you can do for yourself and your loved ones. 10/15/2007 11:11:28 AM

NW_Washington wrote: I agree that it's tacky for receptionists, etc. in medical clinics to foist living wills on people prior to their appointment for treatment. However, this does not negate their important purpose. Living wills, advanced medical directives, and such are documents to provide information about a person's wishes for medical care when no longer able to voice them personally. In the event of a critical medical emergency, this saves the loved one's family from agony trying to guess what that person would have preferred for their treatment. This is not something you do for yourself, but for the people you care about. I opted to do a living will, advanced medical care directive, etc. when I did my will and estate. This gave me time to think out my decisions. My husband died suddenly at age 34 and we had no idea what his wishes were for organ donation, his service, etc. I vowed to not put anyone else in that situation of trying to guess what my wishes are. Maybe when the author gets a little older she will see that it's not about her, it's about making things easier for her husband and family at a time when it's hard enough. 10/15/2007 11:07:38 AM

ad4hk2004 wrote: The author has experienced what physcians live with every day, in spades - that is people waving endless documents in our faces and demanding that we check box and sign them (but only those check boxes 'they' approve, of course) and when we demure, the horrified looks and tongue clicking starts... Little people with little knowledge judging and rating, after consulting their little handbooks of course... The end of our civilation will be when the weight of the bureaucracy crushes the institutions of democracy... A democracy requires that a person can refuse to do the politically correct thing, without be assaulted by cries of "selfish"... 10/15/2007 10:46:10 AM

trichobezoar wrote: I agree with previous posters who found this essay naive. The author stated that she visited her dying father 5 months prior to his death, but I wonder if she saw him again after that. I suspect she did not. If she had, perhaps she might have felt differently about morphine drips. Last week, my family was faced with deciding how to proceed with my father, who developed complications following surgery for cancer. What I would want for myself was not what I thought he wanted for himself, and my mother and I were left to guess. He did manage to communicate his desire to be removed from a ventilator, and he subsequently died. I hope we honored his wishes. And for the record, hospitals, at least this one, inquire about advanced directives for *any* surgery. It's not an indication of whether one's life is at risk. I had a broken finger repaired this summer, and was also asked repeatedly about advanced directives. I guess I was supposed to be offended. One final note - cyanide is not considered a humane drug for euthanasia for any species. Poor example to use, really. 10/15/2007 10:35:21 AM

pgummere wrote: I take issue with Charlotte Allen's assertion that "bioethicists exist for the most part to do some moreal chin-pulling before giving a green light to whatever consensus the rest of the elite have reached." Nothing could be farther from the truth. Within the Catholic bioethics community, we have no problem naming procedures and approaches to end of life issues that are morally abhorent! Among the bedrock principles in Catholic Bioethics are the dignity of the human person and the obligation to respect human life in all its stages. That is NOT to say that we must always do everything possible to prolong life. It is to say that responsible Catholic bioethicist will not be easily hoodwinked into ushering someone into the morgue. Deacon Peter J. Gummere, M.S., M.A. St Johnsbury, VT I invite Ms. Allen and other 10/15/2007 10:35:03 AM

ginniemae wrote: The author flies in the face of her own argument, as the basic reason to have a living will is so that your opinions are respected when you are no longer in a position to voice them. The author clearly has strongly held opinions, therefore, if she would like them honored, that is a perfect reason to get a living will, regardless about how one











feels about assisted suicide. Heaven forbid that she and her husband are in the same motor vehicle crash, her "husband as my living will" won't be able to speak up for her at all. 10/15/2007 10:19:07 AM

DC12 wrote: In addition to a Living Will, you should talk to your attorney about a "Legal Power of Attorney for Health Matters". Simply make it to someone you love and trust AND talk about your explicit desires with them. It is not only just death that is of issue here but ALL medical treatment. 10/15/2007 10:14:29 AM

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haverfilms wrote: Charlotte, I think the inconvenience of being asked repeately to sign your preferences on end of life care is little compared to the troubles raught on Terri Schiavo's family without one. I think her family would not have minded seeing her wishes in writing in 3 different Dr offices. I must say I also found your comment about why a person in a coma would need morphine to be startlingly ignorant for a reporter. Please do a bit of research before printing your column next time and I would expect the Post to do better editing. People in comas feel pain, even deep comas and this is actually a diagnostic criteria for how deep the coma is and how patients respond to it. I might expect this comment in a student newspaper but not a national one and certainly not the Washington Post. We all are entitled to our own opinions but not our own set of facts. I actually believe this error should warrant a retraction. 10/15/2007 10:08:18 AM

sickofspam wrote: The author is an idiot. Living wills don't turn you over to some mythical euthenasia advocates, they simply allow you to choose your own way. And at least in my state, their spouse will not control their health care decisions without a health care proxy. 10/15/2007 10:04:17 AM

DoTheRightThing wrote: Your excellent op-ed piece lays the cards on the table. How can one trust a doctor with one's life, when the doctor may well decide "Your outta here!" when you're not looking? FYI, one well-known bioethicist, Dr. Edmund D. Pellegrino, is on your side of this issue, and has been for the 60+ years of his medical career. Keep fighting the good fight! 10/15/2007 9:40:35 AM

szwheelock wrote: I love all these people complaining about how selfish it is not to want to die. My response: Butt Out. Do what's right for you, and I will do likewise, and if we can mutually respect one another's wishes, well, isn't that what it's about? As for making an "informed" choice, I know from experience with a loved one with dementia that you get only very general information ahead of time, because there are an infinite number of variations, any of which can change your decision at the moment. No, I don't have a living will, mostly because (a) like Ms. Allen, I have a spouse and children I trust to act in love and in concert, and (b) technology changes, and what would seem hopeless under a current DNR order might become no more serious than a fainting spell in the near future. In any event, I'm not formalizing it. My idea of a living will is simple, more so than anything on any of the legal fees-generating forms floating around: If the uninsured cost of keeping me alive is less than the loss of pension or other income or benefits for my wife, she has my permission to keep me going--or not, as she wishes. If the net cost is too much, she can shut off the machines--or not, again, as she wishes. If she doesn't (or can't) care, I'd rather err on the side of living. But it's my choice, dammit, and hers, secondarily, and none of anyone else's business. 10/15/2007 9:23:51 AM

burntnorton wrote: Amen, JLF. It's not just about you, it's about your loved ones and avoiding disputes among them. The author's husband may know her wishes, but what if her children or her parents or her siblings disagree with her husband about what her wishes will be? Most disputes that happen at the end-of-life occur because the family genuinely disagrees about what is best for the patient and about what she would have wanted. ADs can prevent confusion, guilt, and unecessary acrimony among the family. 10/15/2007 9:09:50 AM

edug8tor1 wrote: I also object to her injection of race into this issue, as if the fact that 1/3 as many blacks have living will as whites is somehow indicative of the nefarious nature of living wills, rather than merely another symptom of health care inequities in the US. I shouldn't be surprised since it seems the author's entire article supports her argument using hyperbole and scare tactics rather than real facts. 10/15/2007 9:07:34 AM

pagoff wrote: Health care in our society is a three dimensional problem and we do value patient autonomy. So This woman's desires should of course be honored. Money however is an increasing issue. We spend over 15% of our GNP on care and medical expenses are responsible in some way for 60% of bankruptcy in our country. I wonder what her views are on providing health insurance to children, universal health care or the republican notion that patients, and their families, should pay for the bulk of their own care? 10/15/2007 9:04:28 AM

d1182 wrote: Quite frankly, this author is an idiot. If other people choose to see a difference between being consciously alive and physically alive - prefering the former- then who is she to step in and demand a different set of values. If she wants to be kept alive as vegatable, fine, but let her family bear the financial burden. Her opinion should pertain only to her own physical condition, let others choose what they are comfortable with. Choosing to die when terminally ill doesn't hurt anyone and usually helps the family and loved ones 1) move on and 2) not become broke. Those people are still alive, and sick people should have some consideration for their loved ones, just as their loved ones show for them. This woman needs to keep her religion out of everyone else's decision. 10/15/2007 8:57:54 AM



















Comments





bluebird1 wrote: It is a "LIVING" will! 10/15/2007 8:56:18 AM

JLF03 wrote: How unbelievably selfish! I'm glad the author's husband knows what she wants but, heaven forbid something happens to him, do others in her family know? An advance directive isn't just about YOU. It's also for the people who love you who may be called upon to make decisions for you. I am extremely grateful my father had an AD before he became incapacitated or else I would have faced an unimaginable battle with my sister over his care at an already emotionally difficult time. Making assumptions that people know what you want is setting those people up for perhaps extremely difficult decisions and/or arguments with others who love you and think you would want something else. Advance directives are about protection - protecting you, your family and, yes, even the medical facility you may be in and having one is the right thing to do, even as unpleasant it is to consider one's own mortality. 10/15/2007 8:52:04 AM

rosieindiana wrote: One issue I haven't seen addressed in these comments--why the patient is asked repeatedly if they have a living will. Patients are asked many things repeatedly: What are you having done today? Do you have any allergies? What is your date of birth? Is this your current address? Yes, this is all annoying, but it is designed to reduce the possibility of medical errors. Every person who will be caring for the patient, at each step in the chain of care(admission, pre-op, surgery, recovery room, surgical floor, etc.) needs to know the important facts about the patient, and indeed to make sure they are talking to or treating the right patient. As one commenter noted, a computerized medical record might help reduce the duplication of questions. A "smart chip" with the important data including your living will or advanced directive information stored would help. But from Ms. Allen's tone, I suspect she would view computerized records or smart chips askance, as some kind of conspiracy against her autonomy. Until we have more effective systems, we as patients need to put up with the annoyances to prevent being given meds we are allergic to, or having the wrong breast biopsied, or having our end-of-life wishes contradicted. 10/15/2007 8:39:46 AM

shyto wrote: Sounds to me that the authors religiosity is trumping her intellect. (intellect |ˈintlˌekt| noun The faculty of reasoning and understanding objectively, esp. with regard to abstract or academic matters.) 10/15/2007 8:39:45 AM

timechange28 wrote: Charlotte, You write a very interesting article but you are naive when it comes to the end of life practices. Euthanasia has been practiced in many hospitals for a very long time. When a patient is terminal and in great pain it's not unusual for the physician to order a little extra morphine to help them alone. Would you not want that ? I would. Michael Eure 10/15/2007 8:31:11 AM

barbnc wrote: The "I" generation. I feel, I found, I had, I thought - no room for anyone else in this whining piece of self centered drivel. 10/15/2007 7:47:35 AM

nickwib wrote: A living will is not a moral issue; either you have one or you don’t. But it is surely distressing to be bullied into signing such a thing by strangers for their own bureaucratic or commercial reasons. The thing sounds to me to be badly prepared, badly presented and in need of a bit of spin and polish. 10/15/2007 6:35:34 AM

K3vinFitz wrote: Why a living will? Perhaps it might save your family from an unthinkable burden: keeping alive a body wishing to die. It's easy to see which choice is more selfish and self-centered. 10/15/2007 5:17:15 AM

mongerong wrote: It is a shame that the author doesn't understand living wills. She states that she wants to die 'in peace.' Well,without direct instructions on what you want done, then you will have no say in an emergency situation. As healthcare providers, we are obligated to try and prolong life by any means, unless there is a living will stating that a patient does not want a particular treatment. Without a will, she will definitely NOT die with her desires in mind. 10/15/2007 3:13:39 AM

dzuniga wrote: I have worked in end-of-life healthcare for almost ten years (chaplain, palliative care program, hospice, administrator etc.). An Advanced Directive (AD, living will is not even the right term) is merely to protect the patient. In many states it is free, can be done without a lawyer or notary, and can be changed and/or voided at any time. Even loving spouses do not always honor their dying partners wishes. An AD puts a person’s wishes in writing. It protects the patient and family, because in that ultimate moment they know exactly what their loved one would want, and thus frees them from guilt because they simply follow their loved one’s wishes. An AD doesn’t have to call for withdrawing life support. If you want all forms of life support, no matter what, then you can state that in your AD. Your inaccurate descriptions of Terri Schiavo show exactly why people do need ADs. Her family was at odds. Who is correct? It is impossible to know because she didn’t do an AD. Autopsies etc. proved her brain functioning ceased. The only brain activity was from a tiny portion of her brain stem that still remained. The brain stem controls basic automatic functions, but the part of her brain that controlled things like her memory, her emotions, her thinking processes etc. long ago ceased to be. Her parents had footage of her appearing to smile or wink etc. But they were being deceptive. They would keep cameras focused on her for marathon sessions. Rarely she would involuntarily have muscle reaction. By selective editing they cut tiny clips where it made her look like she was alert. Artificial hydration etc. is often worse for a patient: it can make them experience extreme pain, discomfort and even make them die faster. For example, if a patients liver shuts down and you keep pumping them with artificial fluids you will give them all kinds of terrible problems. It is true that doctors have at times ignored an Advance Directive. But they almost always do it the opposite way that you seem to think; an Advance Directive says to withdraw life support and a doctor continues to allow life support. Doctors are highly trained and professionally motivated. They fear lawsuits. They don’t run around taking people off life support. Your blur important distinctions. For example, “pull out your feeding tube or inject you with cyanide”—again artificial feeding in some circumstances actually makes a patient worse off. Withdrawing a feeing tube allows death to progress naturally as the body is shutting down. Giving someone cyanide is taking an active step to hasten death. There is a world of difference. You state that you felt “harassed” and that people offering you a “living will” cast a “negative pall upon positive efforts to keep me alive.” Why? The reality is humanity is a terminal condition. No one gets out of here alive. Jesus, Muhammad, Moses, Gandhi, the Historical Buddha, etc. all had to die eventually. You and I are no different. Acknowledging our mortality can be psychologically and spiritually transforming. It can fill us with gratitude for every single amazing moment that can be human existence. Denying death, or trying to ignore it, leads to peril. I have been at the bedsides of thousands of dying patients. I have seen families destroyed because they did not know what their loved one wanted or fought based for their own agendas. An AD simply lets all parties involved know what the person would want to be done or not done, what, if any life support they would want or not want. It protects the patient. Your article only spreads fear and misrepresentation. And by the way, studies show that under certain circumstances people live longer on hospice than on chemo etc. Rev. David Zuniga, MDIV, MA 10/15/2007 12:26:33 AM













gordon7 wrote: If Terry Shaivo had made a living will, she wouldn't have been involved in the media circus and you wouldn't have had to "watch her die" (not that you had to anyway.) She could have directed doctors to either keep her alive or not. I know I would rather not live in a vegetative state with no chance of recovery, no chance of ever really living again. So you don't like making a choice either way. Fine. You don't have to. If you felt intimidated, that sounds like a personal problem. 10/15/2007 12:22:11 AM

jbasc002 wrote: Well, the author has her writing career boosting Post article on her resume now. Nicely done. She even took a cheap shot at "the intellectual elite" (as if she isn't one of them). I hope there are no more Terri Schiavos as a result of this total jibberish. 10/14/2007 11:22:27 PM


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jbasc002 wrote: Well, the author has her writing career boosting Post article on her resume now. Nicely done. She even took a cheap shot at "the intellectual elite" (as if she isn't one of them). I hope there are no more Terri Schiavos as a result of this total jibberish. 10/14/2007 11:22:27 PM

realtat1234 wrote: To Aformerjournalist, Thank you for your article. I am surprised at the hostility you have provoked. It is comforting to note that someone dares to take exception to the notion of a duty to die at the convenience of the family or society. 10/14/2007 11:20:32 PM

mrclark9266 wrote: I live in Oregon with a hospice nurse and have learned a lot about this subject over the last 13 years. Of course you should have a living will before you're in a medical emergency. That's why they're asking you while you're conscious. This essay is mostly ignorant nonsense. 10/14/2007 11:04:24 PM

eecee wrote: burntnorton, you make some good points. 10/14/2007 11:03:57 PM

burntnorton wrote: Living wills are problematic, but not exactly for the reasons the author states. Frankly, I'm appalled that she would spread this kind of irresponsible, willfully ignorant, paranoid nonsense rather than providing a reasoned and educational article about end-of-life care and decision making. For my money, a "bullet proof" living will that describes your wishes in excruciating detail is a bad idea. Not because providers and relatives will use it as an excuse to kill you, but because it ties their hands unnecessarily. You simply cannot predict the complex medical situations that could arise in between the time you sign the document and the time your loved ones and doctors need to consult it. Checking "no" on the feeding tube line could turn a temporary disability into a death sentence, for instance. Unless you're actually suffering from a terminal condition, it's much better to prepare a durable power of health care attorney designating a decision maker and a back up that indicates your general preferences (e.g. try everything no matter what, don't try or continue treatment if it would be futile, pull the feeding tube once recovery becomes impossible, etc.). This will help your loved ones make decisions for you if you get hit by a bus without forcing them and your doctors into a poorly fitting straight jacket. More detailed documents are more appropriate for people suffering from terminal and certain chronic illnesses, where the types of medical situations that can arise are more predictable and the personal cost-benefit analysis for certain types of treatment more easy to perform. 10/14/2007 10:25:17 PM

DCDenizen1 wrote: There is little to no discussion here about the fact that medical care is a profit-oriented business. This country does not recognize medical care as a right, and does not support hopitals that have to close their doors because they are deeply in the red. Taking extraordinary measures to keep a body functioning has a disproportionate impact on the cost of health care. It costs a lot of money to provide that level of care. Hospitals are pushing this thing because it has been taken for granted that they will take every measure possible to keep a person's body alive, and the fact is they can do that for a very long time. They are frequently left holding the bill, and they can't afford it. Keeping human bodies alive because their owners lacked the courage and sense of social responsibilty to face their own mortality squanders increasingly limited health care resources. The next time you are waiting for hours in an emergency room to get some illness or injury attended to, think about the doctors, nurses and aides who are preoccupied with keeping a body with no conscious awareness and no hope of ever regaining it alive and breathing, injecting them with medications, monitoring their vital signs, feeding them through a tube and forcing air into their lungs. The next time you read a Sciavo-type story, think about what that care is costing and the impact it has on your insurance company, your state taxes and the availability of health care resources for the living. There is not an unlimited supply of health care professionals in this country. That fact that over 40 million Americans have no insurance and even more are underinsured has kept the strain on health care resources down. But the strain is still there, it's real and it has a direct impact on the quality and cost of care that you are receiving anytime you seek it out. This is part of the problem. 10/14/2007 10:18:09 PM

cjohnsonhi wrote: It is very disappointing that such a poorly informed opinion piece is given a place in a prominent newspaper. A well researched and informed article on neglected and under discussed issue would have been valuable, this drivel just makes me feel a bit sad. 10/14/2007 10:04:42 PM

SP123 wrote: I'm not sure that the author understands what a living will is .... just a way to make your wishes explicit in case of the worst -- whatever those wishes may be. Now days, its a daily occurance for us health professions, especially in intensive care units, to see people sustained on ventilators and artificial nutrition for prolonged stays in the unit. When you watch patient after patient and family member after family member go through this you can't help but say -- God, please don't let this happen to me.


















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Living will is not just for people who want "the plug pulled". Everyone should have a living will because at some point after you've been brain dead for 3 months the people who love you (including the power of attorney) are going wrestle with the question regarding what the right thing to do is. If your wishes are clear to the world it makes it so much easier. It would have made things much clearer if Terry Shiavo had one. I understand it makes some people uncomfortable (you say "annoying") to talk about living will because it makes them think about their own mortality but nobody is forcing any one to fill one out. 10/14/2007 9:54:43 PM

eecee wrote: Aformerjournalist wrote: "Of people who sign living wills, 12% opt for intervention if a procedure is described negatively, 30% opt for intervention if the procedure is described positively. So even if procedures are described positively, living wills still grant permission to permit death 70% of the time. Is it any wonder, then, why some of us wonder why there is so much pressure to sign?" -------------------------------------- If you construe a statement that "IF X fails to help, don't keep it up," then yes, that is permission to "permit death." Of course, that is the most stretched-out and untenable construction you could possibly make, but evidently that doesn't stop you. Nobody's arguing that people shouldn't educate themselves and then make their choices. They can write their own damned scenario...I want a Christian Science practitioner, I want a feeding tube, bring on the hula dancers ... it's up to the individual. In fact, the more self-education and the more detailed instructions based on that self-education, the better. No medical practitioner would ever argue otherwise. But if people are too superstitious or ignorant to do anything, all decisions will be made for them. And that is exactly what you are advocating, whether you think so or not. And if you are congratulating yourself as someone who looks for data, I suggest you look a little closer at Schneider and Fagerlin's thesis. They do not suggest people should not in any case make a living will. Rather, they believe the current method of providing for living wills has failed because (1) most people have not have them, (2) many people who do have them have not always not thought through the instructions in a helpful way, (3) a pre-printed form isn't conducive to articulating subtle choices, (4) they don't always get to the people responsible for making the decisions, and (5) they don't always help the decisionmaker identify the patients’actual preferences. S&F also suggest executing a durable power of attorney for health care decisions - something you repeatedly fail to address. All of the above can be remedied by my earlier suggestion, plus lots of discussion and making sure there are plenty of copies in plenty of hands. (Of course a complete living will does include a durable power of attorney for health care decisions.) Again, glad to see you're a former journalist. 10/14/2007 9:41:09 PM

johnnormansp wrote: Dear Group, I would like you all to softly intone, following me, a message to our dear potential fellow groupie, Aformerjournalist: Now all say politely and monotonously in Unison: "Aformerjournalist, just as we have all personally seen the light and have gracefully submitted in our souls to our civic duty to die, you will see the light likewise, and realize that this is also your own sacred civil duty to society." Now everyone repeat three times, OK? 10/14/2007 9:27:38 PM

matrox wrote: Everyone has a Right to die. Whether terminaly ill or not if a person finds no reason or joy living in this world then he has a right to die and the right to ask for assistence. This is not about money because a dead man pays no bills and please lets not bring moral values into this either for we all know America is one of the most immoral countries on the face of the earth given its history and current actions. Its just fine to kill people in acts of war and aggression whether they be listed as civilian casualties of war or simply those who may be suspected of terrorism after all the $5000 paid to the family members of an Iraqi accidental death is cheaper than a 3 week cruise to the Virgin Islands. So morality regarding the value of life is out of the question, but it could have something to do with keeping the money flowing by draining patients bank accounts in attempts to keep them breathing. Remember as long as patients breath they still have doctor bills. When the family member dies in some cases the family members must then pay those bills. OK maybe I went off a little on this spiel but those wanting to live with tubes in them is just but those who have no use for such and want to die and get it over with should also have that right without having to take the case to supreme court. 10/14/2007 7:46:25 PM

asldkjfaldfgjk wrote: I just wanted to add: If you're really afraid that the hospital will use a living will as an excuse to kill you (even if what it says is "Keep me alive at all costs"), you don't have to give your living will paperwork to the hospital. You can leave it at home until it's really needed. Just make sure that more than one person knows where to find it, in case of that car wreck. 10/14/2007 7:26:31 PM

dehall wrote: A conspiracy under every bed pan. What a depressing world the author seems to live in. Doctors trying to get us. Relatives salivating at the chance to bump us off. Secretaries lieing in wait to trick us. Hospices and old friends prodding the grim reaper to get us faster. And let us not forget that 'living will industry', whatever that is. As a whole industry, it sounds especially scary. I've buried five respected elders in my family. Some feared death and wanted as much treatment as possible. Some, like my mother, a devout Christian, was happy to going to meet old friends and had no fear of death. Each had their wishes respected as well as my sisters and I and our partners and offspring could manage. Fortunately, they were all very old and had unambiguously terminal illnesses, so there were few tough calls to be made. However I would not have hesitated to assist their death if that was clearly and persistently their wish. My love and respect included that. They taught me how to die well, with as much dignity as the process allows us. I hope I can do the same for my children and I hope they have learned to respect my wishes as I respected my elders. As many have said already, it is not about 'assisted death', it is about respect and caring. Sometimes that means assisted death, other times it means using all available means to prolong life. Use the will and power of attorney to make sure your life ends in a way consistent with your wishes. 10/14/2007 7:04:20 PM

asldkjfaldfgjk wrote: I don't really 'get' the author's problem with living wills. Okay, she doesn't want to fill out the hospital's form. Her husband can make choices for her if necessary. Fine. That will work most of the time. Now what if he's dead from the same car wreck that landed her in the ICU ward? Then her family and the hospital go to court, where the lawyers and the judge decide who should make decisions for her. Maybe they'll pick a family member. Maybe they'll pick a professional (a total stranger). Maybe they'll pick









her lawyer. Maybe they'll pick a hospital employee. If she can't go to the trouble of making a recommendation -- any recommendation -- then they'll choose whoever they happen to feel like. A living will doesn't have to say much to be useful. Terri Schiavo would never had made the national news if she'd taken three minutes to write the simple statement, "If anything bad ever happens to me, then I want every possible intervention until I'm definitely brain dead" (or whatever her actual views were). "If my husband's dead, ask my brother" saves the expense of all those lawyers. You don't have to use their form or cover their issues. But do take a few minutes to write out what you think. You can always change your mind later and write out a different piece of paper then. Writing down SOMETHING about your views is one of the things you can do to protect your family emotionally. The worst possible scenario is a family split over the care of a dying person. I can't tell you how many families face a dying person with nasty fights over whether this is "really" what you wanted. Don't leave your husband completely unsupported. Write down the specific issues that you feel strongly about. Write down who should make choices for you. Don't worry about what matteers to the hospital or the lawyers. Just make it plain and intelligible to your family members so that they can be sure that it's what YOU wanted. Remember that most of the Schiavo case hinged on whether the husband was lying about Terri's wishes. She left him with nothing but a verbal conversation. If she had taken just a minute to write down her views (whatever they were), that family would never have suffered as much as they did. Now my question is: Why are you setting up your husband for a similar fate? 10/14/2007 6:55:32 PM

stukerr wrote: Since having read Sherwin B. Nuland, MD's "How We Die", I found this article rather shallow. 10/14/2007 6:36:39 PM

Aformerjournalist wrote: Someone wrote: "... but irresponsible as a model for public policy... But we can release the tortured slaves of pain." You people really can't see why you're scary, can you? You're swept up in groupthink. You've convinced yourselves that it's about being humane. But what you're really doing is constructing a new social duty -- the duty to die. I'll believe your real interest is in being humane when you stop demonizing and vilifying anyone who dares to refuse to go along with you and do their duty. 10/14/2007 6:34:19 PM

roger19351 wrote: Thanks for suggesting the idea of a durable power of attorney. Roger Bell 10/14/2007 6:29:24 PM

linda_521 wrote: It is all about choice, make your choice known. 10/14/2007 6:20:40 PM

jspoteet wrote: You could almost hear the dismissive tone of the quotation marks around the phrase “a good death”. Ms. Allen seems to indicate that she has seen a bad one. But instead of accepting that hard lesson she has embraced a comforting lie; understandable as a personal choice, but irresponsible as a model for public policy. Death is still inevitable. But we can release the tortured slaves of pain. 10/14/2007 6:18:59 PM

Aformerjournalist wrote: eecee wrote: "You still don't get it. The entire point of a living will is to state exactly what you want." Of people who sign living wills, 12% opt for intervention if a procedure is described negatively, 30% opt for intervention if the procedure is described positively. So even if procedures are described positively, living wills still grant permission to permit death 70% of the time. Is it any wonder, then, why some of us wonder why there is so much pressure to sign? eecee also wrote: "Thank goodness you're a former journalist. I'd hate to think you're being paid to make these sorts of illogical arguments." Actually, as a former journalist, I am naturally suspicious of the vilification and demonization of the type I've seen here. I always look for some data. See the article "The Death of the Living Will" by Carl E. Schneider and Angela Fagerlin. They say in academic language, with data, what Charlotte Allen describes from her personal experience. 10/14/2007 6:18:40 PM


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eecee wrote: Aforemerjournalist wrote: "Based on the comments here, I would say the author was wrong when she said that it is 'subtle' pressure applied to the old and ill. I don't think it's subtle at all. You people are scary." You still don't get it. The entire point of a living will is to state exactly what you want so that neither you nor your loved ones are subject to any kind of pressure at all. Thank goodness you're a former journalist. I'd hate to think you're being paid to make these sorts of illogical arguments. 10/14/2007 5:47:30 PM

7900rmc wrote: Ms. Allen, your ignorance and misinformation is breathtaking. And the kind of superstitious suspicion of the medical profession that you exhibit leads me to believe that you are a completely uneducated hick. Write a living will, don't write a living will -- I think I speak for all of us here when I say we don't give a crap what you do. Just please go away and spare us any more of your unsupported allegations concerning a profession about which you apparently know nothing. 10/14/2007 5:38:42 PM

frankmiles3 wrote: The author does not seem to know that she can specify in a living will the person who is to make decisions for her, either following her wishes as stated in the document or substituting his/her own judgment giving the circumstances. Presumably the author would choose her husband. Having a living will with a trusted spouse, friend, or relative designated as the ultimate decision-maker is necessary given the varying attitudes of doctors on when, and if, treatment is stopped. 10/14/2007 5:29:51 PM

johnnormansp wrote: This is more like some sophomore's ill conceived attempt at an essay than anything that merits publication in a newspaper of record. Mushy mushy thinking and ingnorance, from beginning to end. Of course the author has the right to think the way she wishes, but she should write something at least pertinent and meaningful, to keep her job. I'm sure that with his helpful admonishment she will strive harder, and get her career on track. 10/14/2007 5:21:01 PM

kellamd wrote: If she thinks that's bad, try telling the hospital you're not going to breast feed your newborn. Self-righteous Nazis. The ideal of America is that you can live your life as you see fit, not the other guy. 10/14/2007 5:20:41 PM

Aformerjournalist wrote: The vilification heaped on the author of this column is just astonishing, and it proves her point. Based on the comments here, I would say the author was wrong when she said that it is "subtle" pressure applied to the old and ill. I don't think it's subtle at all. You people are scary. 10/14/2007 5:15:58 PM

sjm12561 wrote: She needs to put some more thought into this. Four days ago a friend of mine died of complications from cancer. In the later stages he developed pleurisy and had to have his lungs tapped. He was at this point terminal. But the nurse asked him if he wanted to be resuscitated in case his heart stopped when they did the procedure. He said yes, not really understanding that could mean alot more than having paddles applied to his chest. Cracking his chest, massaging his heart, all for what, to restart a heart in a body that wasn't going to ever get well, to make even more miserable his last few days as he wouldn't heal if they had to crack his chest. And if you think entrusting your fate to someone else is the right answer, you're wrong. They can waffle or do the wrong thing. Better to have it in writing. If Terri Schiavo had written a living will and the state had recognized her husband, not her parents, was in charge of her fate, her life could have ended a great deal sooner and with a great deal more dignity. 10/14/2007 5:02:08 PM

RealChoices wrote: Rlmcca, you have it exactly backwards. Enormous sums of money are spent delaying death for short periods of time. By your logic, people such as yourself and Ms. Allen such have unlimited access to expend societal resources on your lost causes. 10/14/2007 4:51:43 PM

fmb0229 wrote: I suspect living wills are held in abeyance until the money runs out. If you have the money for permanent 24/7 nursing care the good doctors will keep you "alive" forever. 10/14/2007 4:48:22 PM

Va_Lady2007 wrote:




















Comments





Charlotte Allen wrote: "...count me out. I don't want to "die well"; I just want to die in peace." Without a living will, likely someone you don't even know will be calling the shots; whether you find the idea of being hooked up to a machine, chemicals pumped through your veins abhorrent OR whether you find the idea of not making every heroic effort abhorent makes no difference. IF YOU DON'T CHOOSE SOMEONE WILL CHOOSE FOR YOU. The odds are 50-50 they'll make the wrong choice. 10/14/2007 4:38:30 PM

rlmcca wrote: Starving or overdosing the weak and sickly becomes policy once the value of life is eroded. Nationalized health care would likely only hasten the descent as there would never be enough money and bureaucrats would be looking to cut costs. TH 10/14/2007 4:36:56 PM

the1joncook wrote: This seems to be the opinion of someone who has a talent at being oppositional. The reality is no one who advocates a living will is saying you are going to be soon dead. I believe the author could use her considerable talent with the written word for a better cause. "YAWN". 10/14/2007 3:18:35 PM

genedoug wrote: It's impossible to not make a decision. If you do nothing, then you may wind up hooked to a respirator, eyes rolled back, and pumping air through your lungs throughout eternity. 10/14/2007 3:14:29 PM

nardis_miles wrote: What is this woman's problem? This seems a little like the constitutional right to an abortion. If you don't want an abortion, don't have one! If you don't want a living will, don't have one! I guess she wants sympathy because she had to peruse a form that many people fought to bring into existence to find the decline box. I am very glad these forms, and living wills, exist. I am facing a craniotomy in January and I am very interested in availing myself to the very possibilities Ms. Allen finds so troubling, though, even after reading this little polemic, I really don't understand the origin of so deep an anger. Like the abortion issue, is it that she really doesn't want anyone else to have a living will either? 10/14/2007 2:53:51 PM

jasongordon24 wrote: With technology today, we can keep your heart beating indefinitely, thereby perfusing your body and we can similarly ventilate you using various machines. And as the author pointed out, we can feed you in various manners. Theoretically, we could keep people "alive" forever from a physiological and mechanical standpoint. But somewhere between the absurdity of that and no intervention, the living will is supposed to give the informed person some choices when he or she is considered to have the capacity to make those decisions (Many terminal disease patients are considered to no longer have the capacity to make health care decisions such as ending life-sustaining treatment because clinical depression is a disqualifying factor). A physician can treat you as an interesting scientific experiment or he or she can treat you with your desires in mind. I would recommend that anyone who has not seen CPR performed on a human being (not a training model) or has not seen a person dying of cancer in an ICU attempt to visit a hospital so that no matter what decision is made, one is making the most informed decision possible and not basing it off of Hollywood's scrubbed re-enactments. 10/14/2007 2:44:24 PM

jim-freeman wrote: "The problem is that nowadays there is simply no societal agreement on how people who are sick or disabled beyond hope of cure ought to be treated." That's why they are asking you. 10/14/2007 2:33:19 PM

Virginian1 wrote: Quoting the author's alleged fact: "Many people, especially highly educated, nonreligious people, think that "physician-assisted death" is exactly the right way to go." Is that your personal opinion? If that is true, why don't you see the pro-life, or religious groups up in arms about the legitimacy of living wills. 10/14/2007 2:26:39 PM

jennandgus wrote: Elite = posessing a quality superior to others. Elitism = expecting a favored treatment based on social or economic status, an entitlement. Can we stop confusing these two terms? Bush and Cheney have repeatedly made the point that they are not elite. We concur. 10/14/2007 2:05:47 PM

norriehoyt wrote: Charlotte Allen wrote: "...count me out. I don't want to "die well"; I just want to die in peace." What I took away from her article was that actually she just doesn't want to die (who does), and magically thinks that if she avoids a living will/advance directive it's less likely to happen. She's right, though, in saying that at the moment of crisis, these documents are likely to be completely disregarded. At that moment, people will just fly by the seat of their pants and wing it to one conclucion or another. 10/14/2007 2:01:56 PM

democrat4ever wrote: I think you have a fundamental misunderstanding of what a "living will" means. People are NOT going to take you off life support the moment you fall into a coma. And what's more, if you truly want to be sure the feeding tube stays in, then specify it in your living will. This isn't a document to help you die. It's a document to help you decide how you wish to live and whether you want extraordinary measures taken when doctors determine there's no real hope of bringing you back. I'm sorry you had a bad experience with the process, but don't write something, based on a mistaken premise, that may discourage other people from making their wishes clearly known through a living will. 10/14/2007 2:01:00 PM


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PutDownTheKoolaid wrote: Wow. This article reeks of so much self-indulgent ignorance I couldn't bear to finish it. Is Charlotte Allen stuck in junior high school still? The people pushing a living will on her are genuinely trying to help her and her loved ones gain control over the events that will happen in her dying days. And Ms. Allen finds this threatening why? 10/14/2007 1:54:26 PM

Chatelaine wrote: Yes, the woman is misinformed about living wills and paranoid about "those elite people" that are running around hospitals pulling the plug on folks. That is her burden to bear, HOWEVER, the point that could be extrapolated from this diatribe is will there ever be a time when medical resources are scarce/too expensive and such difficult choices, both for the elderly and severely impaired neo-nates, will be made because of the criteria? I hope not, but this is only point I can discern from this woman's diatribe against living wills. 10/14/2007 1:53:57 PM

jennandgus wrote: Once again the WaPo blog outshines the actual column. I am also an intensivist and was planning on adding a comment or two about this misinformed article, but I read this blog and every point had already been said. I'll not reiterate, but just say thanks, guys, and I wish the regular bloggers on this website were running the country, 10/14/2007 1:53:37 PM

RealChoices wrote: Ms. Allen is obviously free to hold whatever moral views she wants but the moral views of her (or anyone else) should not translate into an open-ended entitlement to medical care to keep someone a comatose person alive in perpetuity. In some cases this means using the word “alive” loosely because it is clear the while advanced medical care can keep a heart beating in many cases where the condition is not life as most of us would recognize it. Resources are not limitless, if the choice involved keeping me “alive” at age 95, bed ridden and in an advanced vegetative state or devoting those resources someone younger who can be helped to recovery and many years of productive life, I would prefer society devoted resources to the latter. Ms. Allen doesn’t have to agree but if she wants the former, she should build up her own savings or rely on that of her family to finance the costs. 10/14/2007 1:36:23 PM

shoque1 wrote: I found this 'article' so upsetting, I had to turn off the computer and walk away for a moment. I am a physician currently working in the ICU and am dealing with patients, families, life and death every day. The author of this diatribe is so histrionic and misinformed, paranoid and judgemental that it is a real disservice to readers who want to know more about living wills to read this skewed minority view. The author has every right to sign/not sign a living will and to accept or forgo any medical treatment she wants; no medical professional will deny her that right. However, the assumption that physicians, nurses, respiratory therapists, and social workers are out to euthanize ailing patients the moment they pass out is offensive and delusional. The idea that professionals with years of experience and anyone with views that do not align with hers are all life-eschewing liberal elitists is hysterical and neurotically overwrought. I don't understand where her suspicious nature of the evils of the medical establishment comes from; but it's unfortunate and will only be detrimental if she can not find a physician with common values in whom to place trust. That relationship is the essence to pracicing good medicine for the individual patient. Drawing the line between her faith and science is also disheartening. I know plenty of physicians and nurses who I would call very devout to their faith and religion; as well, I have had many, many patients who were as devout and told me in no uncertain terms that they believe when God wants to take them, it is their time to go. She has every right to conduct her medical affairs in any way she wishes; I am just disgusted by her use of this forum to propagate ignorance, promote her own irrational fears and suspicions, and deride patients and families who make difficult decisions that she does not agree with. 10/14/2007 1:18:50 PM

guyslp wrote: Ms. Allen writes: "The problem is that nowadays there is simply no societal agreement on how people who are sick or disabled beyond hope of cure ought to be treated." and "I wish we lived in a different kind of society, one with agreed ideas about what a "good death" means -- but we don't, at least not now." Both of these points are *exactly* the reason to have living wills *and* to delegate medical power of attorney to someone you trust who will ensure that your wishes are followed. For those of us who work in health care, we know that the hospitals will *always* err on the side of *extreme* caution and "keep 'em alive at all costs" simply because of the threat of lawsuits. I have known of instances where the express wishes of an individual were not followed because they were not in writing of any sort before these issues arose and there was no one who had a power of attorney. As many have already pointed out, living wills are just as much about specifying the sorts of care one does want and insists upon having as what one does not want. This whole article smacks of unreasoned paranoia and ignorance, both of which are entirely curable by educating oneself. Ms. Allen needs to do just that. 10/14/2007 1:02:43 PM

Wadsworth1 wrote: What is this woman's problem? "Go ahead and sign a living will if you want." Thank you, I already have. "But

















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count me out." Fine, that's your choice. Nobody is forcing anyone here. Furthermore, most doctors today do not become doctors because they seek riches (it doesn't pay nearly as well as it used to), they do so because they care about helping their fellow human beings, and I think they would be dismayed by this woman's accusations that doctors are just waiting around to "pullout your feeding tube or inject you with cyanide" as if they don't even care about a person's well-being. 10/14/2007 12:17:25 PM

LynnDeanne wrote: I think the author is misguided about living wills. First of all, you can use a living will to specify that you DO want care - I've had to help my mother fill in those forms she mentions and every one had the option of requesting ongoing treatment. I never felt that the forms advocated one position or the other. That said, they can be tough questions to answer. Do you want to live on a ventilator? Many people think no. But, we discovered when my mother was waiting for a liver transplant that recovery from the operation required the TEMPORARY support of a ventilator. My mother changed her living will. The tougher issue -- and one I certainly hope Ms. Allen's family never faces -- is what can happen when a person does not have a living will. My father-in-law had a massive stroke at home that effectively left him with no hope of ever waking up. While in the hospital he had another stroke. The family begged the doctors not to treat him. Unfortunately, he never wrote a living will. So, even though the family knew what he wanted, and even though the doctors knew he would never wake up, he received life-saving treatment. He lived on for four years... if you call laying in a nursing home bed with next to no brain function and no awareness of anything or anyone around you living. Ms. Allen says her husband knows what she wants. We knew what our father-in-law wanted, but without a living will, there was nothing his wife or children could do to act on his wishes. It sounds like the author would have been happy with the treatment he received. That's her right -- and it is exactly what living wills exist for. In the state he lived in, the doctors had no choice but to proceed with care. That is not the case everywhere. So, if Ms. Allen wants to be sure she stays alive on a feeding tube forever, the wise decision is to write a living will that makes her wishes clear. Durable powers of attorney are great... I have one for my mother, my husband has one for me, and so on. But after dealing with my mother's illness for more than ten years, I can share that there is a key limitation to powers of attorney... they only work if the hospital can reach you. And, you know, sometimes you have to go to the bathroom. Or make a phone call. Or step into the cafeteria for lunch. Or your cell phone dies and you're out of reach as you drive home. A power of attorney doesn't help you or the doctors if they can't reach your husband. And how will he feel if you get treatment you wouldn't have authorized because his cell phone battery dies? 10/14/2007 12:09:47 PM

sophie2 wrote: As many have noted here, anyone who has lingered through the painful death of a loved one know that this writer is very misguided. She is certainly entitled to make her own choices, but allowing her this forum to make her nasty accusations about the medical elite really does a diservice to other families facing tought decisions. Please, allow a person with information the opportunity to respond to this column to express the opposing view. 10/14/2007 11:27:54 AM

swango1 wrote: Two important reasons for a living will: To prevent unnecessary suffering of self and family. To avoid using medical resources in a scenario that does not lead to a better life. 10/14/2007 11:26:22 AM

oriole324 wrote: the very fact that people disagree so vehemently about this topic is why a living will is so crucial. What if you and your husband are in an accident at the same time? Who will make aure your wishes are adhered to then? 10/14/2007 11:15:18 AM

mac3919 wrote: Spend a day in nursing home hallways. Watch a code performed on a fragile person. Figure out how to pay your own medical bills while you linger; my Medicaid taxes should go to people who stand a chance. Write back after you do this. 10/14/2007 11:13:03 AM

rn1956meagain wrote: Again in response to the person whose grandmother was placed on life support against her wishes-----As an RN I have seen this done by doctors who said "yes, the patient has a living will but the family who will sue me is alive" Thank you ambulance chasers!!!! 10/14/2007 11:04:16 AM

rn1956meagain wrote: What is wrong with this person? As an RN of many years I can tell you she is misinformed. Does she not read the newspaper and see what happens to even young people and how does she know her husband will be able to give consent. Why would she want to put her husband in such a painful position? She can make her living will any way she wants to. You know not too many years ago this would not have been an issue. The techniques just did not exist. 10/14/2007 10:58:45 AM

Chasmosaur1 wrote: Ms. Allen - Don't you realize that the living will and medical power of attorney are there not for you, per se, but for your husband? Even the most routine of surgeries can go wrong, leaving people in some form of PVS. After Terri Schiavo, hospitals want people to be prepared for that eventuality. As you noted, many hospitals will frequently ignore living will statements. (When my grandmother - a brittle diabetic - passed away about 5 years ago from a massive cerebral aneurysm, she had DNR on her medical charts, a fact well known by her doctor and my mother, who was her Medical Power of Attorney. The hospital simply went ahead and put her on life support anyway for about 18 hours. My mother was livid and had them remove it, AND successfully had the charges removed from the medical bill, showing that it had been against my grandmother's and mother's wishes.) But sometimes, it's not just the person approaching death who has a problem with the decisions made when healthy - sometimes it's the family. That was the problem in the Terri Schiavo case - her husband/legal guardian felt it was time to let her die but her parents argued the fact successfully (and quite publicly) for years because they were not comfortable letting their daughter pass on. Had she had a living will or a Medical POA, none of it would have happened, and both Mr. Schiavo and the hospital would have had signed documents to that effect. Say (God forbid, *knocking on every piece of nearby wood*) you have a horrible accident and end up in some sort of PVS state. Your husband knows you want to remain on life support. Your doctors and your hospital knows it and agree - but what if your parents or your children suddenly decide they don't actually want to see their beloved daughter/mother "suffer" and fight to have you removed from life support? Having a Medical POA and/or living will (my husband and I have both documents, the former prepared by our lawyer, the latter just a quick notarized document we downloaded from our State's web site) simply helps your husband confirm your wishes. Or, in the case of something happening to you both, whoever your secondary Medical Power of Attorney may be. I do agree that the POA is a better document to have - it's just that a living will form is a lot easier to fill out on short notice.











Perhaps all those forms and medical records should start out with a line: Do you have a living will or Medical Power of Attorney? That would probably help matters immensely. Not to mention making sure that you make your wishes crystal clear to your family and doctor shortly before the procedure. 10/14/2007 10:09:08 AM

notgonnatellya wrote: Ms. Allen's comments reveal a frightening lack of understanding about the concept of a living will. There is no better way to insure that she accomplishes the goal expressed her final comment, "I just want to die in peace", than for her to execute a living will. If she fails to do so, she may well end up dumping her comatose but still-alive body on the health-care and legal professions, and forcing them to try to figure out what to do. What better way to make certain that she "dies in peace", than for her to specify just exactly what she means by that, rather than make others guess at her desires? Ms. Allen and others of her ilk are part of the problem, not part of the solution. 10/14/2007 10:08:29 AM

csintala79 wrote: Charlotte, several commentators have suggested that your opinion might change if you had more experience with the process of death. Yes, it would be instructive for you to spend an extended period of time (at least a week or two, not an hour's visit) in ICUs and nursing homes. While there you shouldn't just observe; you should participate in care. A week or so cleaning up patients living in their own filth, covered with ulcerous bed sores screaming in agony from the resulting pain should do the trick, unless your are totally callous or have an unreasonable fear of death. 10/14/2007 9:53:36 AM

financepirate wrote: I have trouble taking seriously anyone who uses the phrase "intellectual elite" as a pejorative. When did being intellectual become such a bad thing? I should also point out that Terry Schiavo had already discussed her wishes with her husband before she became the unwitting poster-child for intellectually bankrupt conservatives. Her wishes specifically included not living under the conditions she was in. Funny how you think end-of-life decisions should be made between trusted relations (which I agree with), but you think it's okay for you to judge what should have been one husband's decision, and not the whole country's. "Elite" indeed. 10/14/2007 9:51:44 AM

toms995 wrote: As one of those highly educated families, all of us have living wills to prevent the religious busy bodies from making our decisions for us. From our perspective, anyone can have any religious or non religious belief they wish. Doctors, caregivers and all the rest, we have living wills so they don't assume for any one of us that our beliefs are the same as theirs. In addition to our family members looking out for each other, we also have friends authorized to make the same decisions. We, too, want to die in peace. 10/14/2007 9:45:20 AM

edeckel wrote: Strange how this article is written 2 weeks before the 10 year anniversary of my wife passing away but I take great exception to the notion "Right now, my husband is my living will, and after we spent 13 days observing Terri Schiavo exercise her "right to die" by being slowly dehydrated to death after her feeding tube was removed in 2005, he knows exactly how I feel about such matters." I think that you forget that Terri did not have a living will. That was what was the root of the problem in that case. It could become a free for all as the circus played out in the T.S. case. My late wife thought it out as everyone should and had a attorney aid her make her wishes on her what she wanted. What wasn't on paper though is what she wanted me to do if for some reason that her family or doctor did succeed in overriding her desire for treatment limits. It wasn't something that you talk just anyone about due to it's finality it was just between the two of us. I know though that I would have probable gone to jail if I would have needed to carry out that final wish but I would have done it willingly. 10/14/2007 9:37:35 AM


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csintala79 wrote: "They shoot horses, don't they?" Unlike you, I have experience with individuals who went through excruciating suffering while dieing and looked forward to death. Good for you. Hold on to the end. Everyone (although I am continually amazed by Christians frantically grasping at life who should be joyful at the prospect of meeting their Savior and God) should go out as they wish. However, don't take away my right to go out as I choose. 10/14/2007 9:25:57 AM

WashingtonDame wrote: Wow, all this hatred directed toward somebody who DARED to express a dissenting view! Ms. Allen is entitled to think differently about living wills. 10/14/2007 9:22:40 AM

catnj wrote: I totally agree the perspective of the critical care doctor..I'm a nurse who has worked in different level of patient care including hospice... I think this author is inexperienced and ill informed.. and almost naive of her experience 10/14/2007 9:21:16 AM

Ombudsman1 wrote: Hey Charlotte, you are right about the whole thing. Thanks for pointing out the difference between what people say they do and what they actually do. You've made an excellent recommendation. Really great article. 10/14/2007 8:19:37 AM

familynet wrote: If blacks are not signing these wills because of suspiciousness, then they also must be suspicious of obtaining mammograms and other needed health precautions since they too are less likely to obtain these procedures than the general public. So what does that say about this writer’s logic? Oh, and the belief that putting the responsibility on your spouse would have been of no value in the Schiavo case. Florida law already granted him this authority, but the other parts of her family disagreed with him and accused him of unethical reasons for making his decision. I think this woman needs some help of a different type. Assertion training, definitely, mental health counseling would also be of value. Seriously, I’m not saying that to be mean. She tells her husband what she wants him to do, but she doesn’t want to write it in a document? She is just protecting herself from her bad feelings. She has a right to be scared, but she doesn’t have the right to condemn a health issue of which too few people have been aware. Her column came down to only two paragraphs, the first and the last. People ask you about living wills, and she does not want one. Okay so, Don't sign one. 10/14/2007 8:06:10 AM

raqualung wrote: As a critical care physician I have daily experience with dying patients with and without living wills. The writer of this piece is ill informed and sees conspiracy and malevolence where there are none. A living will is by no means inviolate and does not have any contractual or legal significance. Most living wills state the obvious: I do/do not want to be kept alive artificially when there is no hope of recovery. The problem is, how does one define "no hope". What if I am striken with a potentially curable illness despite having a chronic, severe condition that I am certain to die from; not today but maybe in six months? So, like much of life, living wills are guides and not orders. They go to "state of mind", as the lawyers say, and help guide care givers and family in cases where the patient cannot speak for themselves. And many times families knowingly override their loved one's wishes and push on beyond any hope, bringing great suffering, in the selfish desire to keep them alive. Other patients are coerced by family to continue treatment when they themselves want to stop. It happens all the time. The writer talks about "dying in peace", whatever that means. If she meams being kept "alive" on ventilators and with feeding tubes, she and I have very different ideas of "peace". 10/14/2007 7:55:33 AM

petercjohnson wrote: One of the most archaic perspectives I've read in the Post. The author uses a sensational hook, ie "staying alive" to make her point. She fails to acknowledge the living death that becomes possible through medicine. And she ignores the value of making one's own decisions early enough to have one's faculties. The references to facts and trends is helpful, but it is so colored by her simple "pro-life" perspective that it immediately becomes annoying. 10/14/2007 7:22:56 AM

johnnormansp wrote: She writes approvingly of a person in the article who wrote: "If I'm ever in Terri Schiavo's situation, and not in any pain, please follow these simple steps: Keep the feeding tube in, and keep Dr. Nuland ou" -- So, that is a "living will." TIt is therefore clear that this article is not about some irrational pet peeve against being offered the chance to specify what she would like done in certain situations personally -- really what it is, is a thinly veiled diatribe against people's right to simply go away in certain situations, which they have the right to stipulate. 10/14/2007 4:53:01 AM

fake1 wrote: "debater", rather. 10/14/2007 4:09:44 AM

fake1 wrote: Author's point about T.S. case is what a debated might call a "bad point" in that it hurts her own argument.




















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If there was a living will her family, friends, and yes even the country could have been saved that mess. It's unfortunate you have to deal with redundant questions and paperwork. Think of how unfortunate it might be if your family has to make a decision that will tear it apart because you were too selfish to actually make decisions yourself. 10/14/2007 4:01:31 AM

eecee wrote: Aformerjournalist wrote:"My father's shrew of a wife ordered treatment to be withheld, and my siblings had no authority to countermand her orders." ------------------------------------- All the more reason to write down exactly what you DO want. "I want to be kept alive if there is the slightest chance of recovery." "I want pain medications but not for the purpose of hastening my death." "I want hula dancers three times a day." Whatever you want. Write it down. Sign it. It is your decision. What part of that is not clear?????? 10/14/2007 3:35:54 AM

R49Thomas wrote: I'm still working. Do I really need to save for retirement? I'm in pretty good physical condition. Do I really need medical insurance? 10/14/2007 3:25:45 AM

civ1 wrote: To Aformerjournalist "However, your mistake is to assume that all caregivers, and all family members, are people of conscience." I agree not all caregivers are people of conscience, and horrible examples of this exist. But caregivers IN GENERAL, especially those who are involved in life and death care (ICU, Hospice, etc)where these issues tend to surface, are committed to providing excellent and compassionate care to their patients. The implication of her article is that the motivation behind a living will is a systemic scheme to get people to forego treatment. This is just not true. "I am so sorry that it is so, but we cannot assume in these matters that all caregivers are as noble as you. They are not. Elder abuse, I assure you, is real, as is the rush to inherit." Once again, I agree that all of these things occur, and are terrible. But it is not because of "living wills" or end-of-life discussions. Patients need to carefully consider who their surrogate decision maker would be in these situations, and chose someone who they trust and shares their views. If you don't appoint a power of attorney for health care, the surrogate decision maker will be determined by state statute, not you. That is why addressing these issues IN ADVANCE is so critical. "As as caregiver, shouldn't you be willing to tolerate contrary views from those receiving care?" Absolutely, and I do tolerate opposing views every day. I have no qualms with her desire to receive the type of care she wants. I do have a problem with misinformation, especially about this issue. In order for a patient's wishes to be carried out, the discussion must be had, and the patient must TRUST your motivations. Ms. Allen's article undermines patient's trust in caregivers IN GENERAL, without providing evidence to support her characterization. Her view on their underlying motivation is both incorrect and undeserved. 10/14/2007 1:34:30 AM

RossPhx wrote: Living wills, which started out as simple one-page documents with instructions on what to do in cases when life is prolonged artificially, painfully and at great expense, have now morphed into lengthy "check the boxes" documents that assume a great deal of knowledge about current and future medical practices. Both the medical and the legal professions should be ashamed. 10/14/2007 1:27:38 AM

MaximusNYC wrote: "In fact, when I contemplate the concept of 'dying well,' I can't avoid the uneasy feeling that it actually means 'dying when we, the intellectual elite, think it is appropriate for you to die.'" --Just because three different receptionists tried to help you specify exactly what end-of-life care you wanted (including the right to be kept alive thru all possible means!) doesn't mean there is a conspiracy of the "intellectual elite" who are trying to kill you. And it's ironic that you end the article talking about wanting to "die in peace" -- that's the whole point of having a living will. 10/14/2007 1:11:14 AM

MaryAnn3 wrote: This author writes about ethics and religious issues. I find it rather anomalous that she doesn't bring up the 'after-life' issue and the reason why most (religious) people want to prolong existance in this world for as long as possible. But perhaps this subject belongs to the On Faith section of WaPo. 10/14/2007 1:06:12 AM

Aformerjournalist wrote: To clv1: "In my view, Ms. Allen is misleading people about the intentions of caregivers" I have no doubt that you are a caregiver of conscience. However, your mistake is to assume that all caregivers, and all family members, are people of conscience. See, for example, a story in the Oct. 9 New York Times on the abuse of elderly gay people by caregivers. I am so sorry that it is so, but we cannot assume in these matters that all caregivers are as noble as you. They are not. Elder abuse, I assure you, is real, as is the rush to inherit. As as caregiver, shouldn't you be willing to tolerate contrary views from those receiving care? 10/14/2007 1:06:01 AM

civ1 wrote: To Aformerjournalist:











"To those who criticize this essay I say: You are despicable." In my view, Ms. Allen is misleading people about the intentions of caregivers with respect to discussions about end-of-life care. She asserts that caregivers in general are motivated by something other than the desire to provide quality care that is consistent with the patient's wishes. She is dead wrong, and deserves criticism for this view. She has valid points about the shortcomings and hassles in the current system, but they are merely that: shortcomings, not some grand scheme to get all patients to forego treatment. Taking her article at face value will lead some to distrust end-of-life care discussions, which is truly a tragedy, as the discussion often cannot be had when the patient is close to death. This will decrease our ability to abide by patient's wishes. I would think most people would agree that letting the patient determine their end-of-life care (whether aggressive or not) is worthwhile. 10/14/2007 12:24:49 AM

Aformerjournalist wrote: My father died at age 87 of pneumonia. His second wife, a horrid woman if there ever was one (she believed this stuff about the duty to die) gave the instructions to withhold treatment. I was not there, but my my older sister, who has worked in a hospital and with the elderly for years, knew perfectly well that my father was not in pain and that, with life support and antibiotics for hours, as opposed to days, his condition could reverse. My father's shrew of a wife ordered treatment to be withheld, and my siblings had no authority to countermand her orders. Spare me the stuff about decisions being made for the benefit of the gravely ill. At least as often, it's for the benefit of those who want to inherit. 10/14/2007 12:09:42 AM

Aformerjournalist wrote: It is frightening to see how many comments daemonize this essay. Why should anyone call this author "clueless" or condemn the Washington Post for giving her a "platform" for her views? I can think of only one reason. The social engineering project for making death a duty is moving right along. The complaint against the author obviously is not that she made a conscious choice, but rather that she refused to let self-righteous ideologues tell her that it's her duty to die cheaply. To those who criticize this essay I say: You are despicable. 10/13/2007 11:56:06 PM


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civ1 wrote: To Aformerjournalist: "To those who criticize this essay I say: You are despicable." In my view, Ms. Allen is misleading people about the intentions of caregivers with respect to discussions about end-of-life care. She asserts that caregivers in general are motivated by something other than the desire to provide quality care that is consistent with the patient's wishes. She is dead wrong, and deserves criticism for this view. She has valid points about the shortcomings and hassles in the current system, but they are merely that: shortcomings, not some grand scheme to get all patients to forego treatment. Taking her article at face value will lead some to distrust end-of-life care discussions, which is truly a tragedy, as the discussion often cannot be had when the patient is close to death. This will decrease our ability to abide by patient's wishes. I would think most people would agree that letting the patient determine their end-of-life care (whether aggressive or not) is worthwhile. 10/14/2007 12:24:49 AM

Aformerjournalist wrote: My father died at age 87 of pneumonia. His second wife, a horrid woman if there ever was one (she believed this stuff about the duty to die) gave the instructions to withhold treatment. I was not there, but my my older sister, who has worked in a hospital and with the elderly for years, knew perfectly well that my father was not in pain and that, with life support and antibiotics for hours, as opposed to days, his condition could reverse. My father's shrew of a wife ordered treatment to be withheld, and my siblings had no authority to countermand her orders. Spare me the stuff about decisions being made for the benefit of the gravely ill. At least as often, it's for the benefit of those who want to inherit. 10/14/2007 12:09:42 AM

Aformerjournalist wrote: It is frightening to see how many comments daemonize this essay. Why should anyone call this author "clueless" or condemn the Washington Post for giving her a "platform" for her views? I can think of only one reason. The social engineering project for making death a duty is moving right along. The complaint against the author obviously is not that she made a conscious choice, but rather that she refused to let self-righteous ideologues tell her that it's her duty to die cheaply. To those who criticize this essay I say: You are despicable. 10/13/2007 11:56:06 PM

jkbeutler wrote: As an ICU nurse, I am horrified by this article. Clearly this woman has not seen what happens to those who have no living will. 90-year-olds with fluid seeping through their skin from sepsis, dying cell by cell. Its inexcusable. And to clear up a point about a morphine drip, when someone is in a coma, they can certainly still have pain, and worse, shortness of breath which can be very uncomfortable. The doses that are given in the hospital would need to be 5-10 times higher to affect someone's breathing to the point where is would stop. PLEASE PLEASE PLEASE take the time to fill out a living will, you cannot imagine the suffering that these poor souls in the ICU go through. 10/13/2007 11:54:32 PM

curious606 wrote: Woman, you are a joke! A self-absorbed individual with the hubris to think that someone cares about your rambling diatribe against the medical profession. Die anyway that you choose but please spare us your sanctimonious prattle! Please, leave the rest of us in peace! 10/13/2007 11:52:32 PM

civ1 wrote: According to Ms. Allen: "Furthermore, according to a 1990s study by the National Institutes of Health, even when patients have living wills, if those wills contain directives with which doctors and hospitals disagree (such as, I myself suspect, prolonging the patient's life instead of terminating it), many doctors simply ignore the patient's desires." She needs to reference this and other statements, as the largest study from the 1990s (called the SUPPORT trial) and published in the Nov. 22, 1995 issue of the Journal of the American Medical Association showed that physicians did have a high prevalence (49%) of non-adherence to their patient's request to NOT have CPR. In other words physicians were much more likely to be overly aggressive in providing life sustaining treatment. I view this as just as unacceptable, but this study refutes Ms. Allen's argument that physicians (and hospitals) will only abide by the living will if it supports limitations on care. In fact, the opposite has historically been the case. If this is not the study she is refering to she should provide the reference, so we can verify for ourselves. Invoking a study to support her view, not referencing it, and then misrepresenting its findings and conclusion, is sloppy, at best. By the way, she may be surprised to know that 99% of physicians would rather deal with a durable power of attorney for health care in these situations (as she would), as one piece of paper cannot encompass all of the possible treatment decisions that need to be made. I am mystified at her invocation of what sounds like a vast "health care provider" conspiracy to get everyone to subscribe to euthanasia. I think she needs to actually go to an intensive care unit and witness the complex reality of dying which occurs every day in this country before making some of her assertions.
















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10/13/2007 11:51:44 PM

thgreen4938 wrote: Too often, the living will is an easy out for doctors, nurses, and the insurance companies. Give them the green light and they will dispatch you without hesitation. After all, it is your "will." 10/13/2007 11:06:29 PM

missiongwp wrote: What a snotty and obnoxious article. The living will is to make your wishes clear, INCLUDING, if that is your desire, YOUR WISH TO BE KEPT "ALIVE" BY ALL POSSIBLE MEANS. And please get over using "elite" to mean "people I don't agree with and am afraid of." 10/13/2007 10:52:30 PM

w-space wrote: Spend some time watching the terminally ill suffer and you will gain an understanding of what a living will is for. My 93 year old father, suffering numerous ailments including cancer, was revived, one last time, in spite of having a living will. He spent two more weeks in agony before hospice workers helped him along. These people were trying to help you because they see the consequences of leaving these difficult decisions until it is too late. Then their hands are tied and they must keep you clinging to "life" regardless of the pain, humiliation (total loss of control of bodily functions). 10/13/2007 10:39:06 PM

RedBird27 wrote: We did our living wills with our legal wills. The attorney did it all up for us and it's bullet proof. We went with my mother to fill it all in as she was revising her trust as well. She blithely checked off this and that on the Living Will document -- telling us the entire time that she'd never need a feeding tube (she checked no on that) because she wasn't going to live that long. A few years later she's had a stroke and the Dr. says the words "feeding tube." We get the Living Will out, and it says, quite clearly "no." Decision made. Oh how I wish she'd really gotten her wish and not lived long enough to be nearly comatose in her bed needing a feeding tube! I agree that pre-surgery is the wrong time to do this kind of thing. But you need to do it. When we visit and see her we do not agonize over whether we made the right decision - she hold her hand and read her the news of the day. It makes our time with her much easier. 10/13/2007 10:36:41 PM

lindafranke1952 wrote: Signing a Living Will and specifying a DNR is a CYA license freely given to the providers of health care services. The LW is casually handled and it should not be. There is no longer a great deal of trust between the doctor/provider and patient. This is the attitude that we have become conditioned to adopt. Trust is no longer freely bestowed. The LW should be addressed asap when a patient agrees to possible life threatening medical procedures. Not simply an hour before services because it may come into play and that is a serious commitment. 10/13/2007 10:33:56 PM

eecee wrote: This woman's ignorance is stunning. That she is given a platform like the WaPo to spread that ignorance is frightening. Consider this nugget of wisdom: "Right now, my husband is my living will, and after we spent 13 days observing Terri Schiavo exercise her 'right to die' by being slowly dehydrated to death after her feeding tube was removed in 2005, he knows exactly how I feel about such matters." As MsAlley pointed out, this writer presumes that (2) her husband will be there to explain her still-unamed feelings, and (2) that he will not have to fight her other family members to see that they are carried out. Evidently this woman didn't pay much attention to the Schiavo case after all. Don't like the options presented in the pre-formatted living will? Write your own. Be specific, include as many details as you want. Then sign the darned thing. 10/13/2007 10:14:00 PM

Soullady53 wrote: Actually, if you die like Terri you will die in little living pieces, with no brain, and a husband coming to see your comatose self everyday. Yes, that's living well. Apparently you either did not study Terri's case too well, because I will tell you what; I don't want to die like that and my family knows it. I don't want to be an empty vegetable, lying in a bed for years, freaking my relatives out by response stares and laughter. I don't want them to have to visit "me" knowing I'm not even there. You go ahead, babble about not wanting to do a living will, let your relatives plant you in the garden of vegetative state. If the docs say my brain ain't there, I want them to send me on, and please, don't be visiting no damn graves cause I ain't there either. If they feel the need to talk to me they should look up or down, whichever way they think I went, and talk. I'll listen. 10/13/2007 10:11:23 PM

jallen1000 wrote: I think it is inappropriate to ask someone to fill out a living will in the few minutes that have while waiting for their doctor. It should be given as "homework." But just because her hospital repeatedly forced it on her doesn't mean the medical system is out to kill people. You say your husband is your living will. Ok, that's a pretty bad system, for reasons MsAlley pointed out. Also, let's not forget what the Schivo case was all about. Her husband and her family disagreed as to what was to be done with her. How are doctors supposed to know what to do in that situation? If you feel strongly enough about how you want to be treated to write a piece in the post, then you should have a living will! 10/13/2007 10:09:56 PM

morpheusredux wrote: Charlotte, I suggest you sit down with a doctor and discuss exactly what the purpose of a living will is, and why you should have one. You're obviously clueless. 10/13/2007 9:15:24 PM

krrysco wrote: One thing that the writer touches on is that she was continuously asked about a living will. As a nurse, I can tell you that is because most hospitals are still in the stone age when collecting information from patients. I know this because I am a nurse and deal with this repetition every day. If health information was computerized, this













information would not have to be collected over and over again. Also, I agree with the physician who clarified the use of morphine in decreasing "air hunger" (gasping for air). It is difficult to assess pain and discomfort in someone who is comatose, but as a nurse with first hand experience in caring for hospice patients, it does seem to calm the patient. I have never seen it hasten death, and it does decrease anxiety for family who are worrying that their loved one is in pain or discomfort. 10/13/2007 8:54:12 PM

johnnormansp wrote: I respect your right over your own body, and I don't see anything in this article that implies that you, like many religious people, wish to deny my own right to make decsions about mine. So, good article. 10/13/2007 8:37:24 PM

rcubedkc wrote: Wouldn't it have been a lot easier if jeezus had a living will. Dr Mary Magdolin could have climbed up and gave him a big gulp of hemlock. 10/13/2007 8:03:36 PM

dwldwl wrote: So, Charlotte, just how ignorant are you? High school dropout? GED? There are lot of phonies like you rattling around, claiming to be or speak for the common man, while you're raking it in with book contracts, pandering inflammatory garbage to the truly ignorant. You seem plenty elitist to me - it would be hard to assume a more sneering and condescending attitude than yours. 10/13/2007 7:56:45 PM

civ1 wrote: As a physician who is often involved in these decisions with patients and their family members, I can only echo MsAlley's comments. Often difficult decisions need to be made when the patient is unable to participate. In these situations, having a guide to the patient's wishes is valuable to both the involved family and caregivers. Physicians most often approach family members, and the burden of decision is placed upon them. However, many family members feel ill-equiped to handle this responsibility, because they may not have addressed these issues in a frank and open way with the patient. Having any documentation of the patient's wishes becomes valuable when this happens. I do want to address a point that the Ms. Allen made in her article. She asks "why would a patient in a coma need a morphine drip?" Well, often times patients may have problems with pain or with air hunger (a continual feeling of not getting enough air). The morphine is for these symptoms, not to hasten death. This misconception needs to be corrected, as shying away from pain medications in these situations may needlessly lead to patient suffering--real pain and real discomfort, not hypothetical. A "coma" is not a guaranteed protection against this. Most medical providers want to do want the patient would want, not force their values upon the patient. We are motivated by trying to achieve a restoration of health in patients, and also relieve their REAL suffering (not hasten their death). Ms. Allen unfairly characterizes the motivations of physicians and caregivers in her article. 10/13/2007 7:51:18 PM


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civ1 wrote: As a physician who is often involved in these decisions with patients and their family members, I can only echo MsAlley's comments. Often difficult decisions need to be made when the patient is unable to participate. In these situations, having a guide to the patient's wishes is valuable to both the involved family and caregivers. Physicians most often approach family members, and the burden of decision is placed upon them. However, many family members feel ill-equiped to handle this responsibility, because they may not have addressed these issues in a frank and open way with the patient. Having any documentation of the patient's wishes becomes valuable when this happens. I do want to address a point that the Ms. Allen made in her article. She asks "why would a patient in a coma need a morphine drip?" Well, often times patients may have problems with pain or with air hunger (a continual feeling of not getting enough air). The morphine is for these symptoms, not to hasten death. This misconception needs to be corrected, as shying away from pain medications in these situations may needlessly lead to patient suffering--real pain and real discomfort, not hypothetical. A "coma" is not a guaranteed protection against this. Most medical providers want to do want the patient would want, not force their values upon the patient. We are motivated by trying to achieve a restoration of health in patients, and also relieve their REAL suffering (not hasten their death). Ms. Allen unfairly characterizes the motivations of physicians and caregivers in her article. 10/13/2007 7:51:18 PM

MsAlley wrote: Ms. Allen seems very sure that if medical decisions need to be made when she is unable to make them herself, her husband will be willing and able to make them for her. This can be a very risky situation. Suppose she and her husband are in a car accident and neither one is able to make decisions? Who then will make them? It will probably be the health care providers she is so afraid of. She says that she does not want to be eased out of her life by excess sedation or other methods. Is she so sure that if she were in great pain but unable to express her desires her husband will not be able to watch her suffering and do what she does not want? She is afraid that someone will remove a feeding tube or withdraw water against her wishes. The only way to prevent that is to have it in writing in a living will. If she has a living will and her husband is able to make decisions for her he can make sure her wishes are carried out. A written document will give him added athority if he has to argue with doctors about the care she will recieve. She is letting her parinoia get in the way obtaining the care she wants if she is unable to express her desires. 10/13/2007 6:50:33 PM

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back off! i'm not dead yet....oct 14, 2007 · schiavo exercise her "right to die"...

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