Study Challenges Validity of End-of-Life Treatment Decisions

A new study co-authored by UC Irvine professors Peter Ditto and Elizabeth Loftus shows that living wills may not be as effective in honoring individual’s final wishes as previously thought. To carry out this research, Ditto and Loftus selected over 400 individuals above the age of 65 for the group’s project.
“We got people that we knew and actually asked them three times to speak their wishes for different kinds of life-extending treatment,” Ditto said. “We would do that and … ask them to come back a year later and ask the same questions … then we looked to see … how accurate they were in sensing that [their answers] changed.”
Roughly one-third of the group changed their decisions in regards to such treatments as cardiopulmonary resuscitation and being dependent on a feeding tube used to extend their lives. Of these individuals, 75 percent falsely remembered that their new views were consistent with their original choices.
While such ailments as Alzheimer’s disease may complicate the authenticity of a living will, Ditto stated that other factors also contributed to an individual changing his or her end-of-life treatment decisions. For example, if a family member either benefits or suffers due to a life-extending treatment, a person may be either more or less inclined to be interested in the same treatment.
One factor that the study showcased was an individual’s decision toward end-of-life treatments relative to his or her last stay at a hospital. According to Ditto, individuals tend to be less motivated toward life-extending treatment immediately after leaving a hospital, but tend to perk up after three or four months away from a hospital.
Students at UCI had varying views about how reliable living wills are, given the findings of the study. Allen Chiu, a fifth-year political science major, stated that while living wills are inherently flawed, they are closer to a person’s last wishes than any other method that could be used.
“There are obviously problems with [living wills], but even family members can be selfish,” Chiu said. “If I left a living will, I’d want it to be carried out even if it was outdated.”
Alternatively, Christine Verango, a first-year English major, stressed that while living wills should be taken into account, family members’ wishes should also be considered in regards to a person’s last requests.
“The will should matter, that’s what the person wants … but I think family should have a say in it also just because they spent the most time with the person,” Verango said.
Perhaps one of the most well-known arguments in support of the living will is the case of Terri Schiavo. After Schiavo collapsed and suffered severe brain damage in 1990, she was kept in a vegetative state through a feeding tube for 15 years, before the tube was removed in 2005 at the request of her husband.
However, before the feeding tube could be removed, a lengthy legal battle erupted between Schiavo’s husband and her parents over whether the tube should be taken out, since Schiavo had not left a living will indicating her decision. Still, according to Ditto, even if individuals in Schiavo’s predicament keep living wills, their affairs would not be completely sorted out.
“There were many, many people that came on TV and said, ‘If you just take 15 minutes, you can fill out a living will and you’ll avoid all the problems that happened with Terri Schiavo,'” Ditto explained. “I think that’s a dramatic oversimplification of what’s true. I mean just having a living will doesn’t necessarily solve those problems. It doesn’t mean that everybody will agree [and] it doesn’t mean that people will be clear about your wishes,” Ditto said.
Although the study gave evidence that it is flawed, Ditto believes that, the living will is a noble idea that deserves further exploration. According to Ditto, a follow-up study that could be done based on the findings of this study is how end-of-life treatment decisions vary across cultures.
“Traditional European and American culture tends to want a fair amount of control. More like a complete living will. Other cultures – Asian cultures, African-American cultures – have different sorts of feelings. Asian cultures tend to be more family-oriented in their decision-making. … Those kinds of things are all interesting for future research,” Ditto said.
Along with Loftus and Ditto, Professors Maryanne Garry, Jill Jacobson and Stefanie Sharman of the University of Wellington, Queen’s University and the University of New South Wales, respectively, worked on the report.
In closing Garry stated that, while the living will should not be abolished, it should be modified to serve as a more responsible model of an individual’s last wishes.
“We suggest that people should always keep talking to those responsible for their medical care, and living wills should probably expire so they have to be revisited,” Garry said.