Friday, March 25, 2005

Limits of the Law part 2

Interest in Living Wills and the Medical Proxy documents (in Texas called Medical Powers of Attorney) has never been higher because of the Terri Schiavo situation. TV and radio commentators are repeatedly pointing out that the debate over her wishes in the situation would not be taking place if she had left a Living Will or a Medical Proxy. Attorneys, social workers, pastors and health care providers across the country are getting questions about how to obtain and execute these documents.

While I would advise everyone to have a Medical Proxy and a Living Will, these documents will not solve every dilemma that can arise when people are struggling with difficult end of life issues.

A Living Will states your desire not to be sustained by "extraordinary" means past the point where you can be expected to make a recovery that gives you some quality of life.A Medical Proxy appoints someone, usually your spouse, to make medical care decisions for you if you are physically unable to do that for yourself.

However when you execute these documents while still healthy, you cannot possibly anticipate the types of decisions that might arise in the future. When someone who is recently diagnosed with a life-threatening condition makes a living will and a medical power of attorney, they are doing so in the context of being informed about specific possibilities that lie ahead for them. This gives much more assurance and specificity to those charged with giving effect to their wishes.

Another limitation is that others in the family may not be ready to let their loved one die and want to continue to seek treatment past the time that the one in the family with the Medical Proxy thinks is appropriate. I have seen this happen before, and it usually results in a long delay for any decision because the one who can authorize cessation of treatment is reluctant to do so until most of the rest of the family can accept the outcome.

Both of these documents are important, but it is just as important to have frank discussions with close family members about your wishes. That way all of the burden of decision making and consensus is not placed on one person in the family and more of them understand and know the context in which decisions are being made.

Those conversations usually do not happen because they are painful, uncomfortable and unwelcome. The efficacy of the law is limited by our shortcomings as human beings. Today is Good Friday and we remember Christ's suffering for the sins and failings of all men and women on the cross. His sacrifice is a reminder that the law was not sufficient for salvation then, and it isn't sufficient now.

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