Protective Documents

Living wills were a development of EAS advocates and has been largely promoted by right-to-die organisations. EAS opponents have promoted an alternative document.
  • A PMD appoints a family member or friend to make medical decisions if the signer is unable.
  • A PMD explicitly defines and prohibits euthanasia.
  • A PMD specifies that nutrition and hydration are to be provided unless one is unable to assimilate food and fluids.
  • A PMD specifies that the signer is to be provided with ordinary nursing care and medical care, including pain relief and comfort care.
  • Doctors may themselves make quality of life decisions that ignore a PMD.
The first living will document was developed in 1967 by Louis Kutner for the Euthanasia Society of America (now called Choice in Dying) for the purpose of gaining public acceptance of Euthanasia and Assisted Suicide (EAS).1

Living Wills, also known as Advance Directives, are considered by opponents to be less about giving patients control over their health care than about taking away decision-making authority and giving it to the doctor. They also protect the doctor from civil or criminal liability for following proxies' instructions.

A two-part article by author Diana Lynne, published by World Net Daily in October 2005, explores the issue of living wills, following the court-ordered death of Florida woman Terri Schiavo on March 31 2005. 

Lynne mentions an April 15 report by the Robert Powell Center for Medical Ethics Committee which found that doctors and hospitals may disregard advance directives when they call for treatment, food, or fluids if they consider a patient's 'quality of life' too low. 2

Another Option
As an alternative to living wills, documents have been prepared by organisations that are opposed to EAS. One US organisation, the Center for the Rights of the Terminally Ill (CRTI) distributes a "Patient Self-Protection Document" (PSPD). Quoting from their literature:
"This is not a living will. Like a Durable Power of Attorney for Health Care, it enables the signer to name a trusted family member or friend as the 'agent' to make medical decisions if he/she is unable to do so. But it differs from other DPAHCs in that it: (1) explicitly defines and prohibits euthanasia, (2) specifies that nutrition and hydration are to be provided unless one is unable to assimilate food and fluids, (3) specifies that the signer is to be provided with ordinary nursing care and medical care, including pain relief and comfort care, and (4) does not confer immunity on any physician, health care provider or institution who will not honor these instructions."
The International Anti-Euthanasia Task Force provides a similar document, the Protective Medical Decisions Document (PMDD). It is also not a living will. The PMDD:
  • Explicitly defines and prohibits euthanasia.

  • Specifies that nutrition and hydration are to be provided unless death is inevitable AND truly imminent so that the effort to sustain life is futile or unless one is unable to assimilate food and fluids.

  • Specifies that the signer is to be provided with ordinary nursing and medical care, including pain relief and comfort care.

  • Confers immunity on the agent(s) who acts in accord with the instructions but does not confer immunity on any physician, health care provider or institution acting negligently or in bad faith.
The Doctors Decide
Even when there is a signed document expressly designed to protect a patient's desire to live, doctors may choose to ignore it. EAS opponent, RN Nancy Valko, tells of a phone call she received from a woman who was worried about her elderly aunt who had suffered a severe stroke several days before.
"The aunt had signed a protective document designed by a pro-life group as an alternative to the dangerous "living will". The document specifically said that, unless death was inevitable and imminent, ordinary treatments such as food, water and basic medical care were to be provided. The document also named the aunt's sister as the person to make medical decisions if the aunt became incapacitated.

The problem was that although the doctor had declared the aunt's stroke a "terminal event" (a questionable prognosis), she was still alive and breathing, although unconscious. Understandably, the niece began to now question whether her aunt was indeed terminal and whether she should be receiving food, water and basic medical care as her protective document directed.

One of the first questions I asked was whether the aunt was on morphine. (Although strokes rarely cause pain beyond a sometimes initial headache, many doctors and nurses consider unconsciousness a sign that the patient will be severely disabled even if he or she lives, and thus deem such a patient "hopeless".) The niece said that the doctor had ordered the morphine as part of the "comfort care" to prevent any discomfort as the aunt died. I suggested that the niece talk to the doctor and her aunt's sister about stopping or reducing the morphine to see if this was responsible for the aunt's apparent coma. Sure enough, when the morphine was stopped, the aunt began to respond and, according to the niece, even seemed to recognize relatives.

However, the aunt's sister insisted that a priest told her such apparent reactions were "just reflexes" and told the doctor to resume the morphine. The other relatives briefly considered talking to a lawyer about enforcing the aunt's protective document but were reluctant to cause further division in the family. Not surprisingly, the aunt died after two weeks without food and water." 3
Valko, a former hospice nurse and current ICU nurse, believes the best defense is to have a loving relative or friend who is informed about ethical options and who can legally speak for you if you cannot because of illness or injury. She says it is also crucial that you choose a doctor without a "right to die" bias, preferably one with a good understanding of traditional ethical principles.

References:
  1. www.finalexit.org/chronframe.html
  2. Diana Lynne, "Will you be the next Terri?" Part One and Part Two
  3. Nancy Valko, RN, Sedated to Death? When "comfort care" becomes dangerous