Why Should I Want To Make a Directive To Physicians?

There may come a time as you approach death when further medical intervention is fruitless.  That moment causes deep emotional stress to your family members.  If you cannot communicate with your doctor, your family members may dispute with one another, or with your doctor, about what medical steps are appropriate under the circumstances.  Your doctor may be pressured toward providing medical services he believes are not necessary or helpful, and his medical malpractice insurance carrier may support him in doing so.  Further, hospitals have a profit motive in providing care to elder patients, and most health care dollars spent in the United States are expended on persons who die within the next two years.

Given these pressures, you should instruct your doctor about what medical interventions you deem appropriate if you suffer a terminal condition or a permanent unconscious condition (sometimes called a “persistent vegetative state”).

A Washington statute (RCW 70.122.030) permits you to adopt a Health Care Directive, more commonly called a Directive to Physicians or Living Will.  You can instruct your physician (alone) to withhold or withdraw life-sustaining treatment if you are in a terminal condition or a permanent unconscious condition (upon the agreement of two physicians), if these treatments would serve only to prolong the process of your death.  A permanent unconscious condition is an incurable and irreversible condition in which a person is medically assessed within reasonable medical judgment as having no reasonable probability of recovery from an irreversible coma or a persistent vegetative state.  You can instruct your doctor, under these conditions, to allow you to die naturally.  The doctor will look to this instruction of yours concerning medical treatment only if you suffer an incurable and irreversible condition that will, in reasonable medical judgment, result in your death within a reasonable period of time in accord with accepted medical standards, and only if the treatment will serve only to prolong the process of dying.

If the dying patient is pregnant, the directive to physicians has no force during the course of the pregnancy.

Your attorney-in-fact under your durable power of attorney, as well as your family members, should honor your directions contained in this directive to physicians.

The statute permits individuals to make additions to or deletions from their directive to physicians.  Most people want these additions to their directive to physicians, but you are not most people.  You can make whatever additions or deletions or amendments you prefer.  I recommend the following additions to your directive to physicians:

I do want pain medication to alleviate any suffering I might experience.
I do not want cardiac resuscitation.
I do not want mechanical respiration.
I do not want feeding intravenously or by gastro-intestinal tube, or any other invasive or artificial form of feeding.
I do not want to be hydrated intravenously.
I do not want blood transfusion or blood product transfusion.
I do not want any form of surgery or invasive diagnostic tests.
I do not want kidney dialysis.
I do not want antibiotics.
I do not want chemotherapy.
I do not want to receive organ transplants.