Ineffectiveness of Livings Wills Focus of Lawrence University Biomedical Ethics Lecture

A University of Michigan medical school and Ann Arbor VA research investigator argues that a staple of the American medical culture – the living will – does not nor cannot work in the second installment of Lawrence University’s four-part 2004-05 Edward F. Mielke Lecture Series in Biomedical Ethics.

Angela Fagerlin presents “Pulling the Plug on Living Wills: How Living Wills have Failed to Live up to Their Mandate,” Wednesday, Jan. 12 at 7 p.m. in Lawrence’s Wriston Art Center auditorium. The address, which will examine the shortcomings of living wills as well as the use of durable power of attorney as an alternative to living wills, is free and open to the public.

Living wills were originally created as a means of enabling an individual to maintain a certain level of control at the end of their life by detailing the types of treatment a person would like to receive or measures they would like taken should they become incapacitated and unable to make their own decisions. It is a document widely recommended by experts, recognized by law in nearly every state and one that hospitals are federally mandated to inform their patients about.

But in a recently published research paper, Fagerlin and her colleague Carl Schneider claim living wills consistently fail the basic criteria necessary for them to be effective, thus giving them little relevance in actual end-of-life decisions. According to Fagerlin, among the problems with living wills is the inability of most individuals to state their wishes accurately and understandably and having the document available when treatment decisions need to be made. The effectiveness of living wills, she argues, is further compromised by advances in medical technology and changes in an individual’s personal situation. The paper she co-authored was based on a review of hundreds of living wills and end-of-life decisions.

An internal medicine researcher in the University of Michigan medical school’s Program for Improving Health Care Decisions and the Ann Arbor Veteran’s Affairs Medical Center, Fagerlin earned her Ph.D. in experimental psychology from Kent State University. In addition to advanced directives and end-of-life decisions, she has written articles on topics ranging from racial differences in the treatment of prostate cancer to the use of decision aids to facilitate patient involvement in their medical care.