Considering the practical consequences of a living will

I am 81years of age and in good health. Years ago, I completed a “living will” and had conversations with my children about the contents. They agreed that they would respect any decisions I made. I stressed that I did not wish to be revived if I suffered a cessation of heartbeat under any circumstances. My decision has not changed. Recently, the executive of our club announced that we have purchased a defibrillator. Would it be ethical for me to demand that a formal document be placed beside the defib stating my expressed wish not to have these procedures performed on me?

Ethical? Absolutely. Effective? Probably not.

From an ethical perspective, you have the absolute right to specify your desires regarding end-of-life care. You are obviously of “sound mind” and have thought this through carefully, so no problem thus far.

This becomes more difficult, however, from a practical point of view. You’ve made a living will; that’s a good first step. These documents, however, are not all they’re cracked up to be. Presumably you’ve appointed someone to assume Power of Attorney for Personal Care. All a living will really does is advise that person of your wishes. Unfortunately, if you keel over at the club, it’s really unlikely that your POA will be there to act on your behalf. In their absence, well meaning volunteers are likely to zap first and ask questions later; what’s more, first response personnel (paramedics etc.) are required to do whatever they can to revive you when they arrive on the scene. I discussed this problem with Dianne Godkin, Ph.D, Senior Ethicist at Trillium Health Partners in Mississauga. She recommended that a good next step would be to discuss your wishes with your family doctor, and get him/her to sign a “DNR Confirmation Form.” This indicates that you fully understand the ramifications of your decisions, and have made those decisions competently. Godkin recommends that you post this “do not resuscitate” form prominently on your fridge door. Paramedics and other first responders, she claims, are trained to look in such places when they arrive on scene. On the day you fall over, however, your fridge is no more likely to be at the club than is your POA. So, you could certainly get your doctor to make a second copy, put it in a sealed envelope labelled “DNR instructions for Jane Doe” and post it beside the dreaded machine. This is, of course, a very public action, but it sounds like you’re the sort who makes your thoughts pretty well known anyway. And others might follow suit; you could end up with a whole bulletin board full of DNR confirmation forms — wouldn’t that be fun? You could play “Race to the Finish Line!”

I floated one more suggestion by Godkin. “Perhaps,” I mused, “this lady should get the letters DNR tattooed on her left breast — then no one could miss it at the critical moment.” Godkin responded that she’d heard the same suggestion from several nurses. She doubted, however, that such enigmatic ink would stop a zealous paramedic.

Perhaps not. But wouldn’t it make an interesting exhibit during the ensuing court case? Send your questions to star.ethics@yahoo.ca