Should You Have a Living Will? A Christian Lawyer's Perspective
- 2008 30 Sep
You shall not murder.—Exodus 20:13
Rise in the presence of the aged, show respect for the elderly and revere your God. I am the LORD.—Leviticus 19:32
Do not cast me away when I am old; do not forsake me when my strength is gone.—Psalm 71:9
Yet I am always with you; you hold me by my right hand. You guide me with your counsel, and afterward you will take me into glory.
As a father has compassion on his children, so the LORD has compassion on those who fear him; for he knows how we are formed, he remembers that we are dust. As for man, his days are like grass, he flourishes like a flower of the field; the wind blows over it and it is gone, and its place remembers it no more. But from everlasting to everlasting the LORD’s love is with those who fear him, and his righteousness with their children’s children—with those who keep his covenant and remember to obey his precepts.—Psalm 103:13–18
Living wills are documents specifically designed to express our wishes and desires for health care treatment in the event we can no longer communicate for ourselves and we have deteriorated into a terminal condition of permanent unconsciousness (often referred to as a “persistent vegetative state”).
Sometimes, you will hear living wills called “advance directives,” and the terms are synonymous.
Each state has its own laws about living wills, so some of the particulars will vary from state to state, such as exactly how we are to define “permanent unconsciousness.” Now and then, certain court cases make headlines as families and other interested parties wrangle over the precise meanings of some of the key terms. But, as a whole, living wills are quite commonly utilized, usually without incident or dispute.
Before addressing the concerns I have as a Christian attorney with respect to living wills and their uses and possible misuses, let me very quickly discuss the background of how the living will arose. As medical science advanced in the last century, our society experienced a new phenomenon for the first time—individuals with normally fatal injuries and illnesses could sometimes be kept physically alive with the assistance of technology. But if the technology were removed or withdrawn, these individuals would quickly die.
In most instances, the new medical technology was a very good thing. Accident victims could be kept alive until their injuries healed. Victims of certain illnesses, such as kidney disease, could lead years and years of productive life by relying on machines to perform the functions that would ordinarily have been performed by their now-damaged organs. The list goes on and on.
But in some cases, usually where the individual in question had suffered some type of severe brain damage, a new ethical problem arose. What if medical technology could keep a person’s body alive indefinitely? What if that person’s brain was no longer capable of the functions associated with living or “consciousness”? Now what? Was the person really alive? Was the person actually dead, even though many parts of his or her body were still functioning?
Who would have the right to define the meaning of the new term brain dead?
The living will arose as a way to address some of these issues.
Over the period of a decade or so, most states adopted a living-will statute, including definitions of the relevant terms, subject, of course, to further interpretation by the courts. The typical living-will law enables individuals to create legally binding written expressions of their wishes, to be relied upon in the event they should ever slip into an unconscious condition from which no significant recovery is deemed realistically possible by the appropriate medical professionals. Often the living will includes the appointment of a surrogate, or agent, to serve as an advocate for the implementation of the preferences of the unconscious person, as expressed in the written document.
Most living wills request that all further life-sustaining treatment be withdrawn in the event of terminal, permanent unconsciousness. Many also include provisions that medications to keep the unconscious person “comfortable” and free from severe pain should continue to be administered, despite the cessation of other treatments. Obviously, the direct result of following the instructions set forth in most living wills is clinical death of the patient.
Now, the reason I feel it necessary to address the issues surrounding living wills is not so much the typical situation described above, although as a believer in God’s ultimate sovereignty I do have some personal misgivings about even standard living wills (as of this writing, I do not have a living will in force for myself). However, I would be the first to admit that thoughtful Christians hold very diverse views on this subject, and that many denominations and individual churches have studied these issues at great length, many concluding that the standard living-will concept is entirely acceptable from the perspective of Scripture and Christian ethics.
My fundamental concern about living wills arises not from their use as initially envisioned, but rather from the common misuse, misapplication, and misunderstanding of the living-will concept. I believe that God views human life as a sacred thing. However, there are many groups and individuals within our culture who do not share that view. These forces manifest themselves in various ways at various times. Sometimes they act very publicly and boldly, such as through the infamous “assisted suicides” of Dr. Kevorkian or through embracing the horrific practices of partial-birth abortion. But sometimes they act very quietly and subtly. And because, on the surface at least, the living will sounds so reasonable, so innocuous, so acceptable, I believe that those who would actively promote an agenda of death have co-opted the living will concept to cloak themselves in respectability, as they continue to work to undermine the traditional Christian view of human life as a sacred thing.
Here is what I have observed over my years of practice. This is not based on any empirical study, just my observation. I sense there has been a general shift in perception, such that rather than the living will being viewed as something to be thoughtfully, prayerfully, and reluctantly relied upon only after the passage of substantial time and extensive review and consultation with attending physicians, other medical personnel, and loved ones, I now see the living will being viewed as something that should be acted upon in extreme haste, in the very heat of the onset of a medical crisis, before anyone can really discern how permanent or lasting the condition in question will be.
I observe this troubling attitude manifested in clients who ask about carrying their living wills on their person “in case we get in an accident;” I observe it manifested in any number of stories I’ve heard of medical personnel (from doctors and nurses to ambulance crews) treating patients with living wills in the same manner as they would a patient with a “Do Not Resuscitate” order on the medical chart (a Do Not Resucitate order, sometimes called a DNR, is a special standing order to medical personnel not to take any emergency life saving measures under any circumstances, and is normally utilized by a patient who is already very ill); and I observe it manifested in the popular press, where reporters seem to perpetuate these misconceptions about the proper purpose of the living will.
Quite frankly, I believe something dangerous is happening with respect to the way living wills are coming to be understood by our society at large, something that is moving our culture closer to openly embracing euthanasia, or “mercy killing,” for anyone who can’t speak for themselves (even temporarily) and who appears to have poor prospects for resuming a high “quality of life” after an illness or injury.
So here are some considerations for a Christian who prefers to trust in God’s timing, rather than in the timing of someone who can’t or won’t distinguish between a living will and a “Do Not Resuscitate” order. First, you should be aware that although hospitals are generally required to inquire as to whether you have a living will, that does not mean you must have one to be admitted! They simply have to ask. But you aren’t required to answer “Yes”!
Second, you should be aware you can actually make a legally binding, written advance directive that states the very opposite of most living wills. In other words, you can specify your desire for all available health care treatment to be provided to you, no matter what your condition, and your overall preference for life under all circumstances. Secular attorneys may not be familiar with these unique types of advance directives, but many Christian attorneys should be. (If your attorney is not, then please refer them to the resources explaining these “Wills to Live”).
And, lastly, in the midst of any pressure, confusion, or doubt you may experience in wrestling with these end-of-life issues, please do not forget that each of us is a precious child of the King of the universe, a treasure to him of inestimable worth, and that his timing is perfect!
*This column contains generalized information only and is not intended as a substitute for the specific legal advice of your own attorney. Excerpted from The Believer's Guide to Legal Issues (Living Ink Books, an imprint of AMG Publishers, 2008). Copyright (c) 2008 by Stephen L. Bloom. Used with permission. All rights reserved.
Stephen L. Bloom is a Christian lawyer serving clients throughout Pennsylvania. He wrote The Believer's Guide to Legal Issues (Living Ink Books) and frequently speaks on Christianity and law. For information, visit his website http://www.istherealawyerinthechurch.com