May 22, 2024

Just words: rethinking living wills with speech-act theory

What do people mean when they make living wills?

Remember the battle over what brain-damaged Florida woman Terri Schiavo would have wanted if she were conscious? The case for removing life support rested on the claim that she had said that she would have wanted a feeding tube to be removed. With more cases like hers coming before the courts, lawyers are advising people to make living wills. But how valid are statements, oral or written, made in the past about present preferences?

A recent article in the Journal of Medical Ethics tackles this difficult topic. In “Significance of Past Statements: Speech Act Theory”, Joanne Gordon contends that past utterances do not always express a person’s preferences for how she would like to be treated. They can only be intended to provoke a psychological reaction in her listeners.

Gordon uses speech act theory — a philosophical theory about the nature and significance of verbal utterances — to analyse statements about end-of-life care. People may not intend that their statements express a treatment preference. Rather, they want to create a particular impression — to comfort, to shock, to inspire, and so forth. For example, the statement “I don’t want to be dependent on others” may not necessarily express a treatment preference. Rather, “an individual could conceivably be acting insincerely to generate a perception of himself/herself as a fiercely independent”. Gordon also offers the example of comments made to a loved one in residential care:

“’I hope when I’m older I end up somewhere nice like this’ or ‘I’d love to be waited on hand and foot’…It seems reasonable to suggest that [the speaker] may not possess any such positive thoughts or attitudes about dependency but is using these words purely to bring about a comforting or reassuring effect.”

Gordon concludes that “Speech act theory shows us that statements can also be ‘hollow’ groups of

words, which we frequently use with the sole purpose of bringing about psychological effects on our audiences in everyday social interactions.” She concludes that greater attention be given to the context in which utterances are made, their consistency of other statements, their overall personal narrative. 

Xavier Symons
Creative commons
advance directives
living wills