New report: Living wills doomed to failure

They run afoul of human psychology

While many palliative care quality professionals encourage the use of advance directives, a new report published in the bioethics journal Hastings Center Report by a University of Michigan internal medicine researcher and a professor of law and internal medicine claims that living wills don’t — and can’t — work.1

According to the authors, these documents, designed to help people choose the treatments they would like when dying, fail to meet five key criteria for success. Worse, the evidence suggests they don’t work. The study authors based their conclusions on a comprehensive review of hundreds of studies of living wills and end-of-life decisions, and of the psychology of making choices.

The researchers conclude that living wills offer a false promise of control over end-of-life treatment. The best patients can do, they argue, is to use a durable power of attorney to appoint someone to make decisions for them when they can no longer make their own decisions.

"Living wills don’t fail for lack of effort, education, intelligence, or good will," says study co-author Carl Schneider, JD, a UM Law School and Medical School professor. "They fail because of basic traits of human psychology."

For instance, he says, studies show that people have great trouble predicting their own preferences about even simple, everyday things, like what snacks they will want or what groceries they will buy next week. "If they have trouble predicting what is familiar," asks Schneider, "why should we expect them to succeed when they are predicting what they will want in circumstances they have never experienced and can’t foretell?"


1. Fagerlin A, Schneider CE. Enough: The failure of the living will. Hastings Center Report 34; 2:30-42.