In 1967 What Entity Devised The Original Living Will

In 1967, Who Devised the Original Living Will? Exploring the Origins of Advance Healthcare Directives

The concept of a living will, a document allowing individuals to express their wishes regarding medical treatment in the event of terminal illness or incapacitation, is now widely accepted. But its origins are rooted in a specific moment in time: 1967. Pinpointing the single entity that "devised" the original living will is complex, as the idea emerged from a confluence of legal, ethical, and societal shifts. However, we can explore the key players and events that led to its creation and eventual widespread adoption.

The Precursor: The Evolving Legal and Ethical Landscape

Before 1967, the legal and ethical frameworks surrounding end-of-life care were significantly different. Patients had little control over their medical treatment if they became incapacitated. Decisions rested solely with family members or physicians, often leading to unwanted life-sustaining treatments that prolonged suffering. Several factors contributed to the growing discontent:

1. Technological Advancements in Medicine: The post-World War II era saw remarkable advancements in medical technology, particularly in life support systems. While these advancements saved lives, they also raised ethical dilemmas. Individuals could be kept alive artificially, even when there was no hope of recovery or a reasonable quality of life.

2. The Rise of Patient Advocacy: The burgeoning patient rights movement pushed for greater autonomy and self-determination in healthcare. People increasingly demanded the right to make choices about their own bodies and medical treatment, even if those choices were difficult or controversial.

3. The Influence of Legal Scholars and Philosophers: Legal scholars and bioethicists began to grapple with the ethical implications of prolonged life support and the need for a legal mechanism to reflect patients' wishes. These thinkers played a crucial role in shaping the intellectual foundations for the living will. Their work highlighted the importance of respecting patient autonomy and avoiding unnecessary suffering.

Enter the "Living Will" Concept: 1967 and Beyond

While no single entity can claim sole credit for the creation of the living will in 1967, the year witnessed pivotal developments that significantly shaped its emergence:

The Publication of "A Patient's Bill of Rights": While not explicitly a living will, the publication of a Patient's Bill of Rights in 1967 by various medical organizations signaled a major shift in the relationship between patients and healthcare providers. It emphasized patients' rights to information, consent, and participation in their care. This laid the groundwork for the legal recognition of individual preferences concerning medical treatment. Though not a living will itself, it highlighted the crucial need for such a document.

Early Legal Cases and Legal Scholarship: Several landmark legal cases during this period indirectly spurred the development of advance directives. Courts began to grapple with situations where patients were unable to express their wishes, leading to decisions being made based on family opinions or interpretations of what was considered "in the patient's best interest," rather than the patient's wishes. Legal scholars began to advocate for a more formalized process, prompting the development of legal frameworks to respect patient autonomy.

The Role of Evolving Social Attitudes: Societal attitudes towards death and dying were also changing. A growing openness to discussing death and end-of-life care contributed to the emergence of the living will. People were becoming more willing to consider their own mortality and to plan for the end of their lives.

The Catalyst: The First Published Living Will?

While identifying the single originator remains elusive, it's crucial to understand the evolution of the concept. Several individuals and groups contributed to the development of living will-like documents during and after 1967. The precise first instance is hard to definitively claim, as many individuals may have drafted similar personal documents prior. However, several influential figures and publications played a significant role in popularizing and formalizing the concept:

• The work of Louis Kutner: Many cite the work of lawyer Louis Kutner, who, along with his colleagues, drafted a document similar to a living will, although it may not have been widely circulated or publicly available in the way living will forms would become later. His work, along with others like the work of Dr. Herbert Hendin, focused on improving end-of-life choices and patient autonomy. His contribution was instrumental in the gradual development of standardized formats.

• The "Declaration of Patient's Rights and Responsibilities": Several medical and healthcare associations in the late 1960s and early 1970s also began to draft declarations around patient rights. Whilst not exactly a living will, they emphasized the importance of respecting patient autonomy and their right to refuse treatment. These documents acted as precedents for later living will legislation.

The Evolution of the Living Will: From Concept to Legal Instrument

The living will, as we know it today, wasn't created overnight. It evolved through a gradual process of refinement and legal recognition:

State-by-State Legal Recognition: The acceptance of living wills varied significantly across different US states. Some states were quicker to adopt legislation recognizing the validity of living wills, while others were slower to acknowledge their legal force. This varied pace reflects the different legal and societal contexts within each state.

The Development of Standardized Forms: Over time, standardized living will forms emerged, making it easier for individuals to express their wishes clearly and concisely. These forms helped to reduce ambiguity and ensure that patients' instructions were understood by healthcare professionals.

The Rise of Durable Power of Attorney for Healthcare: In addition to living wills, the durable power of attorney for healthcare became increasingly important. This document allows individuals to designate someone else to make healthcare decisions on their behalf if they become incapacitated. It provides a mechanism to address situations where a living will may not adequately cover all possible circumstances.

The Living Will Today: Ongoing Challenges and Advancements

While the living will has played a crucial role in advancing patient autonomy and improving end-of-life care, it's important to acknowledge ongoing challenges:

Legal and Interpretational Variations: Legal interpretations of living wills can vary across states, leading to inconsistencies in how they are applied in practice. Ambiguities in wording can also create challenges in interpreting a patient's wishes.

Ethical Dilemmas: Even with a living will, ethical dilemmas can still arise. Healthcare professionals may face difficult decisions, especially in cases where a patient's wishes are unclear or conflict with their medical judgment.

Advancements in Advance Care Planning: In recent years, there has been a shift towards more comprehensive advance care planning. This involves not just a living will but also a discussion with family members, healthcare providers, and the development of a broader plan that addresses all aspects of end-of-life care.

Conclusion

The creation of the living will wasn't the work of a single entity in 1967, but rather the culmination of various legal, ethical, and societal factors. The year marked a critical turning point, with the publication of important documents and the growing legal awareness of the need for such a mechanism. While various individuals and groups contributed to the concept's development and formalization, it was a collective effort that led to the living will's gradual acceptance and its evolution into the comprehensive advance care planning tools we have today. Its legacy continues to evolve, prompting further discussion on improving end-of-life care, patient autonomy, and the ethical considerations involved.