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Advanced Directives: Living Wills and Durable Power of Attorney

Since the mid-1970s, Right to Life of Michigan has consistently opposed recognizing "living wills" in Michigan law. Though we support the right of patients to make their wishes known about future medical care, living wills do not protect important rights that incompetent patients require. Because advances in medicine and treatment decision-making are dynamic in nature, Right to Life has firmly held that decisions for incompetent patients must be made by a duly authorized surrogate who can work with the medical staff in the best interests of the patient. Living wills, due to their static, in many cases "fill-in-the-blank," nature can actually hinder the decision-making process, introducing ambiguity and uncertainty.

Medical professionals acknowledge that the best way to respect patients' personal autonomy is to give them all the facts about their condition and treatment options, then allow them to make decisions based on that information. This is the principle of "informed consent." Living wills cut at the heart of informed consent. Because they are written in advance and usually in very broad terms, living wills remove the option of patients being treated based on the facts of their present condition. Instead, patients are treated based on general statements made in advance of any knowledge of their condition or possible advances in medical technology. Along with this disadvantage, living wills exclude family members from participating in treatment decisions for their loved ones. The potential for abuse in their application is also great. Living wills remove the human, compassionate element from a critically important decision-making process.

By contrast, Michigan has the most comprehensive durable power of attorney for health care law in the country. Other states which began with only living will laws have used Michigan's durable power law as a model. Our law allows patients to write down their wishes as part of the durable power designation. Patients in Michigan make their desires known and still have their rights protected. Recognizing living wills in law would simply be offering citizens a needless cheap substitute to the top of the line power of attorney.

Living will proponents argue that living wills are needed because some patients have no one whom they can appoint as their patient advocate. If patients have no one they trust to appoint as advocate, they have no basis for believing that a physician will feel bound by the generic instructions of a living will. There will be no one to hold the physician accountable. Simply put, a piece of paper can not make decisions, nor can it protect a patient's rights or advocate on his or her behalf. The control and autonomy promised by living wills are empty promises.

Right to Life of Michigan remains firmly opposed to granting legal recognition to living wills through legislative enactment.

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