Living wills offer a false promise of control over end-of-life treatment, claims a study in the bioethics journal Hastings Center Report. Researchers at the University of Michigan based their conclusions on hundred of studies of living wills, end-of-life decisions and the psychology of making choices. A “durable power of attorney” is a far better option, they contend.

Dr Angela Fagerlin, of the University of Michigan Medical School, says that living wills fail all standards of workability. “First, most people don’t even have living wills. Second, those who do rarely know what care they would truly want in some hypothetical future. Third, it’s surprisingly hard for people to state their wishes accurately and understandably. Fourth, the document is often unavailable when decisions need to be made. Fifth, even when it is available, surrogate decision makers usually cannot reliably apply its instructions to the patient’s current health condition.”

Co-author Carl Schneider adds that most people cannot predict their preferences about next week’s groceries. “If they have trouble predicting what is familiar,” he asks, “why should we expect them to succeed when they are predicting what they will want in circumstances they have never experienced and can’t foretell?”

The authors argue that a power of attorney is simpler, allows the decision-maker to act in the light of the current situation and costs less. They also found that there is no convincing evidence that living wills save money by reducing the cost of end-of-life care.

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