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					  LIVING WILLS A CONTEST BETWEEN PITY
            AND COMPASSION


What is a Living Will?


       A living will is a document prepared in anticipation of a terminal illness. It
contemplates the inability of the signer to direct his/her treatment decisions and
instructs the physician to withhold or discontinue all medical treatment which may
prolong life or is believed to be useless.


Where Did Living Wills Originate?


        Living wills were first advocated by the Euthanasia Society of America and
are viewed by most proeuthanasia groups as the initial step in the legalization of
euthanasia. In 1975 the Euthanasia Society changed its name because the term
euthanasia evoked strong reminders about the atrocities carried out by the Nazis
in their euthanasia program. Along with other groups, including the Hemlock
Society, Exit and Concern for Dying, they have led the campaign to popularize
the idea of living wills and have worked successfully for the passage of living will
legislation in 37 States.1


Are Living Wills Recognized in Canada?


       No unlike the United States. living wills are not recognized as legally
binding documents in Canada and physicians are not bound to follow them. After
studying many recommendations to accept living will legislation, the Law Reform
Commission concluded that they were unnecessary and counterproductive.


Are living Wills Necessary?


       No, the Criminal Code of Canada already provides protection for adult
patients against unwarranted or undesired medical treatment. Firstly, the Code
affirms that treatment performed without legally effective consent constitutes an
assault [against the person]. Secondly, law recognizes the basic common law
approach which upholds [the individual’s] right to refuse treatment, even life-
saving treatment. Lastly, the decision to terminate or discontinue useless
treatment is a well-established ethical practice, which in the view of the Law
Reform Commission of Canada, eliminates the need to enact specific living will
legislation in our country.2


What About Incompetent Patients?


       The protection of patients who cannot express their own wishes and
decisions is very important. Sound and acceptable criteria is imperative to protect
those who are unable to protect themselves. Again the Law Reform Commission
has identified the acceptable practice in such cases. The first criterion is of a
medical nature wherein the physician judges and weighs the benefit and / or
uselessness of treatment. The next criterion, equally import, is based on the
patients wishes. If a person has not, or was never capable of expressing their
wishes, the determining principle must be the best interests of THE PATIENT.
Families and relatives are usually regarded as those best suited to determine the
best interests of their loved one. In certain cases the best interests of the patient
may be met by prolonging life, while in other cases, cessation of treatment which
is no longer of benefit may be indicated. If conflict arises between the judgment
of the family and the physician, the court are the appropriate forum in which to
examine and resolve disputes.3


Can a Patient be Require to Sign a Living Will?


        Some doctors in Canada promote and even urge the signing of a living
will, however, no one can be required by a doctor, hospital, or any heath care
facility to the sign such a document. Nor are they required to sign the Proxy
Designation which is sometimes a part of living will forms.


What Are the Danger of Living Wills?


        Because living wills attempt to predict future events, they are by nature
broad and generalized. The terms which are used are vague and therefore open
to serious abuse. As example, the following text is taken from the Living Will
distributed by Dying with Dignity Society (Vancouver):

       Being of sound mind, make this statement as a directive to be followed if
for any reason I become unable to participate in decisions regarding my medical
care.

      I direct that life-sustaining procedures should be withheld or withdrawn if I
have an illness, disease or injury, or experience extreme mental deterioration,
such that there is no reasonable expectation of recovering or regaining a
meaningful quality of life.
       These life-sustaining procedures that may be withheld or withdraw
include, but are not limited to: Surgery, antibiotics, cardiac resucitation,
respiratory support, artificially administered feeding and fluids.

       The will concludes with space for the signature of the individual and that of
two withnesses.

There are numerous reasons why a patient may be unable to participate in
decision-making. Medication, depression, mild senility are just some of the
factors which may impair decision-making. Would these individuals automatically
come under the provisions of the will?

If Experience Extreme Mental Deterioration


Does this mean that Alzheimer’s patients and others suffering serious
mental disorders can be denied life-sustaining procedures?


       No Reasonable Expectation of Recovering or Regaining a Meaningful
Quality of Life

       This statement mistakenly assumes that the point of hopelessness can be
known with accuracy. In addition, a meaningful quality of life means very different
things to different people. Many stroke and spinal injury victims, people with
cancer or diabetes, all have a reduced quality of life. Is worse than no life at all?
Who decides what is a meaningful life for another person?


Life-Sustaining Procedures…Include, But are not Limited to…


       In other word there is NO LIMIT to the care that can be denied. It could
include such ordinary medical treatment as insulin, nitroglcerin, antibiotics and
oxygen. While artificially administered feeding and fluids are stipulated, what of
ordinary feeding and liquids? Can they be denied?

       The above directive is an open invitation to serious abuse of an
incompetent patients right to treatment and care. It is in fact, a directive for
passive euthanasia, a crime Canadian law describes as culpable homicide, in
other words, murder. If the directive were followed as set out, the patient would
not die as a direct result of deliberate starvation, dehydration and lack of
ordinary, basic care. It should be a cause of great concern to Canadians that this
living will is already in use in at least one extended care unit (ECU) in Canada.
Further, it contains a clause which purports to morally [bind] families, physicians
and others. No one can be morally bound to agree to euthanasia murder.
Why are “Living Wills” so Controversial?


        The danger and controversy surrounding living wills arises primarily over
efforts to enact specific legislation to give these wills the force of law. Living wills
encourage the mistaken notion that all physicians will try every means to keep
patients alive as long as possible. There is a largely unwarranted fear. Although
living wills may offer some potential reassurance to certain individuals, their
dangers far exceed their value. As Dr. Elisabeth Kubler-Ross stated before the
U.S. Senate Committee on Aging, such legislation because of its loopholes would
allow elimination of those lives that are too costly or too much of a burden.4 This
view is shared by many legal, medical and ethical experts. The concerns are
well-stated by one expert who comments: Such approaches as legalized
euthanasia and the Living Will are based upon the misconception that the point
of hopelessness can be known with accuracy and that the physician, unless
prohibited by law, may uselessly prolong suffering. I fear that unless people
understand the false reasoning behind these concepts the physician’s hands
may be tied in just those cases where his skill and modern technology can make
the greatest contribution to the saving of lives and the control of disease.5


Conclusion


       There is no legal, ethical or moral obligation to prolong life simply for the
sake of prolonging life. Drugs given to ease pain, even if they have the
unintended side-effect of shortening life, have long been recognized as sound
medical and ethical treatment. To intentionally kill an individual because they are
dying, judged hopeless or lacking in a quality of life, is still murder even if
motivated by pity. There are two sorts of pity: one is a balm and the other a
poison…6 The ambiguous and broad interpretation which may be given to many
living wills is an invitation to let our compassion be twisted into a harmful and
destructive poison. Genuine pity demands that we recognize that matters of life,
health and death are personal and unique to each individual; that our human
obligation is to provide comfort and care in the face of this singular experience.



    He wanted to warn—don’t pity me. Pity is cruel. Pity destroys. Love
    isn’t safe when pity’s prowling around.
                                             Graham Greene
                                            The Ministry of Fear



        Of itself, a living will is not morally objectionable. In simple from it is a
letter, document or even verbal statement which sets forth the wishes of an
individual not to have the dying process prolonged by heroic or extra-ordinary
means if they become terminally ill and death is inevitable. But beyond this, living
wills pose genuine dangers. Persons seeking to prevent unwarranted, extra-
ordinary measures may be unintentionally authorizing their own death not from
the course of a disease, but by starvation and dehydration.

Footnotes

       1.New Wills Allow People to Reject Prolonging of Life in Fatal IIIness, The
Wall Street Journal, July 12, 1986

    2.Euthanasia, Aiding Suicide and Cessation of Treatment, Law Reform
Commission of Canada, Working Paper 28, (p.69)
    3.Ibid . (p.70)

      4Deaths, Dying and Euthanasia, Dennis J. Horan and David Mall,
University Publications of America, 1980. (p.366)

       5.Ibid. (p.364)

       6 Charles Sumner, American statesman

				
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