Leslie Wolf, professor of law
It helps us make good decisions at difficult times.
A hundred years ago, most people died in their homes surrounded by their families. Now, the vast majority of people die in hospitals. Their families often must make decisions about their care, because the patients are unable to do so themselves. These decisions can be wrenching for family members, uncertain about what the patient would want. But the law provides a mechanism for helping family members make those decisions in accordance with the patient’s wishes.
Since the 1990s, every state had adopted legislation authorizing advance directives, a mechanism for patients to specify the medical treatment that they are willing and unwilling to accept. Patients also can identify the person they would like to act on their behalf if they are unable to do so. That person – the health care proxy or agent – can make all the decisions the patient can. This includes the right to refuse life-sustaining treatment.. They also protect health care providers who follow the choices reflected in a valid advance directive or made by a health care proxy.
While advance directives are important to allowing individuals to make decisions about their own medical care, they are also vitally important to helping families through extraordinarily difficult medical decision making. Families often are reluctant to refuse medical care when that refusal could lead to the patient’s death. However, when the patient has expressed their own preferences, families can let go of guilt and act the way they know the patient would want.
Advance directives are not perfect. Because illness and medical care are complex, they often do not cover the specific circumstance that the precise circumstance that the patient faces. However, they can serve as a guide to navigating that situation. And they can help resolve disagreements among family members about care choices by serving as a reminder of the patient’s goals.
But completing advance directives can also prompt important conversations about dying. I have personally been involved several times in difficult decisions for family members who could not speak for themselves. What a gift it was to have had those conversations so that I could feel the decisions that I made were consistent with what the person I loved would have wanted.
Leslie Wolf, professor of law, is the incoming director of the Center for Law, Health & Society.Back to Law Week