On Living Wills
One of the pieces of settled conventional wisdom that seems to be emerging from the Terri Schiavo story is that living wills are an unalloyed good. I'm not so sure.
SoxBlog, speaking from the experience of one with Cystic Fibrosis, speaks of the "failure of imagination" that can beset youth and health when asked to contemplate age and disability. This is actually part of my problem with living wills. They're obviously tremendously practically useful, but they have real problems. They place in the hands of one person (the healthy me of now) the power to make medical decisions for another person (the incapacitated me of later) despite the fact that the former may have an inaccurate sense of what the latter's condition is actually like, certainly has no experience with the subjective experience of what it's like to be the latter, and may have a genuine conflict of interest (revulsion at being associated, across time, with a person in such a degraded state). "I wouldn't want to live like that" is, I think, more a descriptive than a predictive statement. It says a great deal about the person speaking, and far less about the person with respect to whom medical care will one day be administered or denied. It may be that any alternative method for determining whether to provide medical treatment in extremis is even worse and that we ought to stick with the living will formula as our default, but we should do so with the realization that, at best, the living will is a least-worst solution. (And, by pointing out the living will's problems we might actually help fix them, by encouraging people to actually think seriously about what life would be like in, say, a persistent vegetative state, or a minimally conscious state, rather than simply blithely assuming that it's an existence of meaningless torture that no one rational would prefer to death.)
SoxBlog, speaking from the experience of one with Cystic Fibrosis, speaks of the "failure of imagination" that can beset youth and health when asked to contemplate age and disability. This is actually part of my problem with living wills. They're obviously tremendously practically useful, but they have real problems. They place in the hands of one person (the healthy me of now) the power to make medical decisions for another person (the incapacitated me of later) despite the fact that the former may have an inaccurate sense of what the latter's condition is actually like, certainly has no experience with the subjective experience of what it's like to be the latter, and may have a genuine conflict of interest (revulsion at being associated, across time, with a person in such a degraded state). "I wouldn't want to live like that" is, I think, more a descriptive than a predictive statement. It says a great deal about the person speaking, and far less about the person with respect to whom medical care will one day be administered or denied. It may be that any alternative method for determining whether to provide medical treatment in extremis is even worse and that we ought to stick with the living will formula as our default, but we should do so with the realization that, at best, the living will is a least-worst solution. (And, by pointing out the living will's problems we might actually help fix them, by encouraging people to actually think seriously about what life would be like in, say, a persistent vegetative state, or a minimally conscious state, rather than simply blithely assuming that it's an existence of meaningless torture that no one rational would prefer to death.)
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