Why do we need a living will? Premium

A living will ensures your treatment preferences are honored, preventing unnecessary suffering and easing family decision-making during critical times.

Birth and death represent the two ends of a person’s timeline. A disproportionate amount of preparation, attention and care is given to the first half—ranging from the anticipation of pregnancy, counseling and checkups, to delivery and extravagant first birthday celebrations. Unfortunately, the same attention is rarely given to the opposite end – that is death. It is often left to chance, fueled by the vague hope that ‘the right treatment decision will somehow be taken at the right time by someone.’

Therein lies the problem. No one—not even a doctor—knows exactly how their life will end, or whether they will be able to speak for themselves in their final days. It could be a relatively sudden event or a long-drawn-out process following a severe, irreversible illness. That choice isn’t ours to make. Ultimately, failing to plan ahead is often what separates a peaceful, dignified passing from a prolonged and distressing ordeal for the patient and their family.

A living will is a legal document that safeguards the individual’s treatment preferences for certain irreversible conditions, essentially taking the burden off relatives and doctors in deciding on treatments in specific situations. Not having one could sometimes lead to crucial treatment decisions that the patient would not have made by themselves, needlessly prolonging their suffering.

The focus of a living will is specifically for situations in which the person develops a medical condition that is terminal or irreversible. There will be no compromise in routine treatment measures for other illnesses. For instance, a college lecturer suffers a brain injury from hypoxia after a near-drowning incident in a river. The person is paralysed, opens their eyes but cannot recognise anyone or respond—a condition commonly referred to as a persistent vegetative state. This could also happen following head injury, choking on food, strangulation or a stroke. In such situations, not only is recovery not generally possible, but the person may remain in that condition for prolonged periods—painful for the family to watch and also expensive in the long run. Another example is a person with metastatic cancer at a stage where further treatment offers no improvement, where the person may be better off receiving comfort care (palliative care) than remaining in the ICU receiving more rounds of chemotherapy that only diminish quality of life in the limited days that remain.

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Most people would expect their family members or close friends to step in and take the right decisions along with the doctors. However, in reality, the situation can turn chaotic because of emotional conflict, guilt, differences of opinion and contrasting attitudes among several decision-makers—at the end of which doctors will often take the safest route possible: continuing every treatment measure prescribed in the books, without consideration for quality of life or prospects for recovery. In addition, our next of kin may not be alive or available to make these decisions for us in the distant future. A safer alternative is for individuals to document their preferences ahead of time, when they are still in good physical and mental health, and also discuss it in advance with family members so that there is no conflict if and when the time comes.