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Lenworth Jacobs and colleagues have a startling article, "Trauma Death: Views of the Public and Trauma Professionals on Death and Dying From Injuries," in this month's Archives of Surgery. A brief interview about the article is available at MedPageToday.

Jacobs et al. found that 61.3% of the public and 20.2% of professionals believe that a miracle can a save person in a persistent vegetative state. 57.4% of the public and 19.5% of trauma professionals said divine intervention can save a person when doctors think treatment is futile.

On the tough question of when to stop life-sustaining treatment, 72.8% of the public and 92.6% of professionals think if there's no hope for recovery, the focus of care should shift to the comfort of the dying patients. Moreover, among the whopping 27.2% who disagreed, 86.2% said treatment aimed at recovery should continue regardless of cost and half of those said it should continue aggressive care even when it meant taking resources away from those with a better chance of life.

The Rochester Democrat and Chronicle reported yesterday that "the Appellate Division of [the New York] state Supreme Court refused . . . to extend the deadline for legal challenges to plans to remove Dorothy Livadas, 97, from life support at Strong Memorial Hospital."

Earlier this year, the local trial court removed Livadas' appointed agent, her daughter Ianthe, and instead appointed Catholic Family Center as Livadas' guardian. With the appellate court now stepping away, the trial court's order stands. Since the basic reason for replacing the substitute decision maker was Ianthe's refusal to consent to removing Livdas' life support, CFC should make that decision shortly.

The decision seems correct. Livadas clearly stated in her living will that she did not want to be kept on life support were she in the condition in which she is indisputably now in. Since Ianthe's health care decisions for Livadas contradicted instructions in Livadas' living will, Ianthe was a bad agent and had to be replaced.

But let's not forget that while Livadas' living will clearly applies to the present circumstances, the result is still premised on the assumption that Livadas' living will accurately represents her preferences. Ianthe argued that since Livadas signed many legal papers the same day she signed her living will, it is unlikely that she put much thought into it. Indeed, it is likely that many living wills (instructional advance directives) accurately reflect the preferences of declarants. But the presumption is that they do. Ianthe just could not bear the heavy burden of rebutting this presumption.