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Make a living will
Views The columnist Chanda PrescodWeinstein wants to save our helium p22
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Comment
Make a living will For our own sakes, and for those we leave behind, we all need to think about how we want to die, says Clare Wilson Clare Wilson is a medicine and health reporter for New Scientist. Follow her on Twitter @ClareWilsonMed
JOSIE FORD
B
Y THE time you read this, Vincent Lambert may well be dead. He has been in a vegetative state since a car crash in 2008. In a twilight zone between life and death, he has been unable to talk, eat or respond meaningfully to others. Last week, doctors in Reims, France, began to remove his life support following a ruling from the Court of Cassation, the country’s highest appeals court. It followed a six-year legal battle between two sides of Lambert’s family – his wife and six brothers and sisters, who sought to let him die, and his parents and two other siblings, who wanted him to continue to live. The case
brought interventions from politicians, the Pope and the United Nations Committee on the Rights of Persons with Disabilities. Whatever our views on this case, most of us would think it is sad that Lambert’s family, who presumably all care deeply about him, have been fighting over his fate in court. The problem is that few of us like talking about death, so few of us take an important step to ensure that our loved ones know how we wish to be treated at the end of our lives – in situations such as this and in far more common ones. That step is to make a living will, or advance decision, a document
that sets out your medical preferences if you are unable to communicate. In the UK, groups such as Compassion in Dying and Advance Decisions Assistance provide free templates online and advise on how to help make sure these documents don’t get ignored when they are needed. In the US, the National Institute on Aging website provides advice. Many people would want all the medical treatments available to be thrown at them if they were unable to communicate their wishes, and worry that medical staff will give up too soon. It is their right to express that wish. But talk frankly to doctors and they will tell you the bigger
problem is the opposite: of overtreatment and inappropriate medical care that makes death more unpleasant and prolonged. It can be just as important to state clearly in what situations you wish to avoid certain treatments. For example, sometimes people in hospital who are dying and have stopped eating and drinking as their body shuts down will have a feeding tube placed through their nose, causing distress and discomfort. Often families pressure staff to do this because they can’t accept how close their relative is to death. Then there are people who aren’t dying, but who have very poor quality of life because of severe Alzheimer’s disease, for instance. Would you want to continue living in that situation? While assisted dying is illegal in the UK, as in most countries, it is legal to refrain from treating infections such as pneumonia, to let people die naturally. This used to be more common, but is often now resisted by relatives or care-home nurses. Some people object strongly to such a course, while others see it as being sensible and humane. The range of opinion is the crux of this matter. Unless you make a living will, it won’t be you who decides what happens to you at the end. It will be someone else. ❚ 13 July 2019 | New Scientist | 21
Letters Consciousness really does pose a hard problem p24
Aperture A kitsch celebration of the epic Soviet space dogs flights p26
Culture Artist Olafur Eliasson explores the Anthropocene p28
Culture columnist Simon Ings delights in The Hummingbird Project p30
Comment
Make a living will For our own sakes, and for those we leave behind, we all need to think about how we want to die, says Clare Wilson Clare Wilson is a medicine and health reporter for New Scientist. Follow her on Twitter @ClareWilsonMed
JOSIE FORD
B
Y THE time you read this, Vincent Lambert may well be dead. He has been in a vegetative state since a car crash in 2008. In a twilight zone between life and death, he has been unable to talk, eat or respond meaningfully to others. Last week, doctors in Reims, France, began to remove his life support following a ruling from the Court of Cassation, the country’s highest appeals court. It followed a six-year legal battle between two sides of Lambert’s family – his wife and six brothers and sisters, who sought to let him die, and his parents and two other siblings, who wanted him to continue to live. The case
brought interventions from politicians, the Pope and the United Nations Committee on the Rights of Persons with Disabilities. Whatever our views on this case, most of us would think it is sad that Lambert’s family, who presumably all care deeply about him, have been fighting over his fate in court. The problem is that few of us like talking about death, so few of us take an important step to ensure that our loved ones know how we wish to be treated at the end of our lives – in situations such as this and in far more common ones. That step is to make a living will, or advance decision, a document
that sets out your medical preferences if you are unable to communicate. In the UK, groups such as Compassion in Dying and Advance Decisions Assistance provide free templates online and advise on how to help make sure these documents don’t get ignored when they are needed. In the US, the National Institute on Aging website provides advice. Many people would want all the medical treatments available to be thrown at them if they were unable to communicate their wishes, and worry that medical staff will give up too soon. It is their right to express that wish. But talk frankly to doctors and they will tell you the bigger
problem is the opposite: of overtreatment and inappropriate medical care that makes death more unpleasant and prolonged. It can be just as important to state clearly in what situations you wish to avoid certain treatments. For example, sometimes people in hospital who are dying and have stopped eating and drinking as their body shuts down will have a feeding tube placed through their nose, causing distress and discomfort. Often families pressure staff to do this because they can’t accept how close their relative is to death. Then there are people who aren’t dying, but who have very poor quality of life because of severe Alzheimer’s disease, for instance. Would you want to continue living in that situation? While assisted dying is illegal in the UK, as in most countries, it is legal to refrain from treating infections such as pneumonia, to let people die naturally. This used to be more common, but is often now resisted by relatives or care-home nurses. Some people object strongly to such a course, while others see it as being sensible and humane. The range of opinion is the crux of this matter. Unless you make a living will, it won’t be you who decides what happens to you at the end. It will be someone else. ❚ 13 July 2019 | New Scientist | 21