"A living will is a sure way to guarantee that you will get substandard medical care.
You are indemnifying the hospital/doctor against neglect."
That is probably one of the most ill-informed comments that I have seen on this Board (and there have been many that the Schiavo case has elicited).
A living will provides your family with some direction at a time when it can be very difficult to make decisions. More importantly, one should TALK and DISCUSS his/her wishes with family so that there are no disagrements. Again, the responsibility is to fulfull the wishes of the patient.
A quote from an editorial by Dr. Quill:
In considering such profound decisions, the central issue is not what family members would want for themselves or what they want for their incapacitated loved one, but rather what the patient would want for himself or herself. The New Jersey Supreme Court that decided the case of Karen Ann Quinlan got the question of substituted judgment right: If the patient could wake up for 15 minutes and understand his or her condition fully, and then had to return to it, what would he or she tell you to do?
NEJM April 21, 2005 issue Volume 352:1630-1633
flixxx, I am sorry that I came back at you like that.
I understand the good intentions of Living Wills and Advanced Directives.
I was a big supporter of them myself about 15 years ago.
I was one of about 15 other people that testified before my state legislature in 2000 about the unintended consequences of
this act.
1)In most states if you are over 65 there is a formula for determining judgements in cases of medical malpractice for death.
It is usually a combination of factors but earning capacity is a huge chunk of it. What would you earn if you lived out the rest of your natural life.
At 65 and over, it is nothing. It doesn't matter what your life means to your family. Only what you can earn.
2)If a hospital does something less than lethal you can sue for pain and suffering, but if they kill you or let you die they come out far better.
Scenario's where I have seen this happen.
79 year old man , previously in good health, had an MI. Came out of ICU in modestly compromised , but improving condition.
Heart rate went to 160, MD was not called. He went itno pulmonary edema and died. Hospital liability 0.
Could have been converted out of SVT with a dose of Cardizem.
2) 69 year old patient 2nd post op for Prostate surgery. Doing well, no malignancy. C/o of being Short of Breath, staff put some oxygen on him.And went no further. Next check he was dead from a pulmonary embolism. Hospital liability 0.
3)Lady 72 comes in with Pneumonia, started on antibiotics, started chilling ,temp went to 104. Tylenol was given but the physician was not called. She was septic, went into septic shock, got moved to ICU in the morning but shock was so advanced that all interventions failed. Hospital liability 0.
4) 69 year old lady, in an MVA. Had a fractured femur. Was admitted and scheduled for surgery the next morning. Checked at midnight, B/p was trending down and heart rate was trending up. Physician was not called. Dead at the 4 am check. Autopsy revealed a lacerated liver. Hospital liability 0.
It is like racial bias. It's not overt, It's not blatant and out there. Staff, especially younger staff has the attitude that if you are a no code that you are comfortable with the idea of your own death.
Because of over work, because of attitude, because of ageism, hospital staff is more likely to over look subtle signs of impending crisis.
I spent 10 years working in ICU, I had a young wippersnapper nurse actually state "What are they doing in my ICU, they are a no code". I snatched her into a conference room and bawled her out.
No Code is supposed to mean no heroic measures. Increasingly it is being used to mean No Concern.
I know your heart is in the right place.
If you have a terminal illness, an Advanced Directive might be in your best interest.
If you are in good health but just getting older and there are things that you do or don't want, you are far , far better off having a very frank discussion with someone not in your immediate family and with no financial interest and preferably with extensive medical knowledge.
Sign a durable power of attorny for medical decisions only.
There are many things that can happen that are not lethal, and something like a ventilator can be a temporary bridge to recovery.