In a debate that all too-frequently becomes polarised, living wills (or advance directives as they are also called), used to be a familiar battle ground. ‘Pro-life’ and ‘Pro-choice’ campaigners would line up on opposite sides of the fence.
Things have moved forward since then. Some of the groups that saw the change coming was a Christian-based organisation that calls its living will document Five Wishes. The passage of legislation in various jurisdictions not only helped to publicise what was already accepted as a legal principle, but helped to create a wide-ranging attitude shift. Far from being opposed to living wills, many faith-based groups now actively support and encourage them, as demonstrated on this post today from the Christian Science Monitor. EXIT provides members with options on three documents. Most people like to start with something quite basic about their end of life wishes. But those wanting the best legal protection need not only a fuller document but need to put considerable thought into filling it out. Finally, apart from purely medical directions, there may be things that are important for people to bear in mind. Your general outlook on end-of-life issues, people you do or don’t want to be around you. Funeral arrangements. Or just the things that are important to you that you want to be able to enjoy while you are alive. The things that make life worth while. These are contained in a document we provide called a Values History (which can be downloaded free of charge from the main EXIT website).
Legislation has also reassured people. The safeguards are more out in the open. No-one is worried that signing a living will means they could be ‘bumped off’ by avaricious relatives and uncaring doctors. Legislation could do the same for many circumstances where a kind act can be portrayed as something more sinister. Or a lack of transparency mean risks that sound legislation could effectively counter.
Take for instance this rather picturesque story yesterday where a Catholic nun allegedly provided mercy killing using morphine. Did the Auburn Sisters Of Mercy nun actually lock herself in a room with a sick nun, sing songs and apply morphine until the sick woman died? It could be the substance of a Hollywood movie. But one can imagine details either way – a loving act towards a colleague who desperately wanted that kind of aid to die, maybe just shortening the dying by a few minutes – or something dreamt up by a disgruntled ex-employee. It is not so much whether one is for or against such procedures – but more whether legislation forces such things into secrecy. And distinguishing loving acts from ‘Harold Shipman’ scenarios. Denying people the options altogether means people assert their own will by effective but hazardous means, such as Margaret Page, who starved herself to death over sixteen days at the St John of God rest home.
At the other end of the scale is a sad story in today’s Scottish newspapers about a man with no apparent illness who committed suicide using the freely available information on the website of an organisation who has similar name to our own. Before we throw up our hands in horror, we have already said that preventing from committing suicide by one method simply increases the deaths from suicide by other methods (as was apparent when North Sea Gas meant putting one’s head in the oven was no longer a lethal option.) It is difficult to assert ‘one correct’ moral answer – especially without the benefit of hindsight. Better social conditions, better understanding and support – all these things might help. Do our principles still hold if looking at a less sympathetic case, such as the embezzler Kathy Borrego, who committed suicide with helium – again with no physical illness. Exit is committed to providing self-deliverance information. Any organisation that does so has to define its own sense of responsibility in such matters.
Basic living will document (free to download and modify responsibly)
Values Histories More about them, and sample questions you can download and use
NHS video about making advance directives
Advance decisions to refuse treatment – an NHS guide for patients
Advance decisions to refuse treatment – an NHS guide for professionals
Patient UK guide to living wills
Patients’ Association guide to living wills
Be specific in your advance directive (an older, thought-provoking study)
Sample policy document on advance directives (Scotland, NHS Lanarkshire)
MND Scotland factsheet on advance directives
UK Government guidance (ukgov) on making a living will