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Living wills may be damaged by legislation

As a doctor who has specialised in the care of the dying I have often thought about how I would like to be treated when close to death. Should I write down my thoughts now just in case I am too weak to speak one day - and if I did, should my "living will" be legally binding on all who read it ?

The main reason why euthanasia and living wills are so much in the news is because of bad medicine. It is a scandal that people are still dying in terrible pain because of ignorance or obsession with cure at all costs. Many so-called technological advances are simply medicine gone stark raving mad.

Medics are trained to make people better and are often hopelessly frustrated by incurable illness. Medics also have to publish research to get top jobs so there is pressure to try out unproven treatments. Quality of life can disappear under a forest of needles, wires, electronic gadgets, and needless operations.

Time after time I have seen those who are dying with AIDS or cancer trapped in hospitals waiting for useless tests when they could be at home. Others in coma following accidents or strokes often linger for months, hovering in that twilight zone between life and death, sustained by massive effort even when there is no hope of any kind of reasonable existence in the future.

The machine is unthinking and the results can be horrific. A friend went into hospital at the age of 75 with advanced cancer for an exploratory operation which showed massive tumour. A day or two later she had a heart attack and was dying peacefully. Despite her expressed wishes for no heroics the "crash" team was called and violent attempts were made to revive her with massive electric shocks and injections. She died anyway - without peace or dignity because no one had stopped to think.

As a reaction to all this many are now writing down in advance what they want to happen at the end and want it legally binding. Communication is always a good thing and anything that helps a doctor to understand his or her patient's wishes is to be encouraged. Many treatment decisions are difficult and a strongly expressed view can be very helpful - even if written in advance.

It can be hard to be allowed to die - and I am not talking about euthanasia which is a deliberate act designed to kill. If I was dying of very advanced cancer with many complications I would make it absolutely clear to my doctor that my next pneumonia should be my last. There is no need to "strive officiously to keep alive" when the end is in sight so why pump me full of antibiotics ?

However once a written directive is backed by law then doctors risk prosecution if the exact wording is not followed regardless of circumstances - medicine by lawyers. But how could you agree if you thought the person might have been depressed, under pressure or feeling a burden? How could you be sure that every medical option had been fully explained and understood ? There is also doubt over our ability to get the diagnosis or prognosis right. These issues also affect the euthanasia debate. Many legal experts say an Act of Parliament for Living Wills could be a back door route for legalised euthanasia.

Involving police, magistrates, judges, jury and prisons is no way to care for the dying - much better to encourage good communication, compassionate common sense and expert appropriate treatment taking into account the expressed wishes of the individual.

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