Philosophy 230
Answers to Study Questions:  Fagerlin and Schneider, "Enough:  The Failure of the Living Will"

Note:  While some of the study questions are factual, others are evaluative.  The evaluative
questions can obviously be answered in a variety of ways, and you should not hesitate to
develop your own ideas.  Be sure to get back to me if you have any questions about
these answers.

1.  The authors set out 5 conditions that would have to be met in order for a system of living
wills to be effective:  1.  People would have to have them; 2. People would have to know
how they want to be treated should they become incompetent; 3. People would have to be
able to convey those preferences clearly and precisely in writing; 4. Living wills would have
to be available when the need for them arises; and 5.  The professionals or family members who
are making health care decisions for the patient would have to interpret the document properly.
(see pg. 393, 7th ed.)

The authors argue that none of these conditions are currently being met, and they argue that several
of them could not be met.  It seems to me that the issues they raise for 2. and 3. above are the most
crucial.  In contrast, if the issues they raise in 1. and 4. above were the only problems with living wills,
then there might be ways of solving those.

2.  I'll focus here on their development of the claim that people don't know their own treatment
preferences.  They offer a variety of reasons why people don't know what they want.  First, people
don't even know what rights they have.  The authors cite a study in which it was discovered that
only 46% of subjects were aware that they had a legal right to have life-sustaining treatment
withdrawn.  Second, people do not know the details about the variety of illnesses that might leave
them incompetent, nor the treatment alternatives available to them in those situations.  Third,
it is common for people's preferences to change over time.  These problems would seem to be
very difficult to overcome.  For example, it is hard to imagine how the average patient could
be expected to have the relevant medical knowledge for all the conditions that might render her
incompetent.

3.  As we suggested in class, I think the best response on the part of defenders of living wills might
be to modify their aspirations for these documents and argue that they can be very useful
in certain specific circumstances.  For example, many people have strong views about how they
would want to be treated should they find themselves in a "persistent vegetative state" (PVS) (no
doubt the case of Terri Schiavo raised awareness of this issue).  Since PVS is a specific
and extreme condition, it is relatively easy to create a document that specifies exactly how
you want to be treated should you find yourself in exactly that condition.  Also, DNR orders
can be useful for patients who, due perhaps to their age and medical condition, see no point
in having CPR performed should they suffer cardiac arrest.  These are examples of specific
situations in which advance directives could be very useful, even if the authors have succeeded
in showing that they cannot be expected to be helpful in most cases.