Sometimes a person's medical condition precludes them from expressing a preference about their treatment and the responsibility lies entirely with others. Sometimes a person’s medical condition allows them to express their preferences. What happens, though, when someone expressed preferences in the past regarding conditions that exist now — should those preferences be heeded?
A common way that people express their preferences for how they will be treated in the future is through living wills — official, legal documents which state which sorts of treatments they accept, which ones they don’t, and under what conditions this should occur. Even more common is perhaps just making general statements to friends and family members. Although such statements are not legally binding, they can have force in any court proceedings. Such witness testimony was used in hearings during the Terri Schiavo case, for example.
People don’t typically express preferences on future medical treatment for every possible condition. Usually, these preferences are limited to specific and extraordinary conditions. For example, it’s common for one to express the wish that if they fall into a persistent vegetative state, then neither ventilators nor feeding tubes be used to maintain life. Elderly patients and those suffering from fatal diseases may state that they not be forced to undergo CPR if, for example, they have a cardiac arrest.
One might think that heeding such preferences would be obviously appropriate, but there has been serious controversy and disagreement over them. Some argue, for example, that we can’t reliably predict how we will want to be treated for some future condition, and if we are unable to express our preferences at the time, then decisions should be made by those with our best interests at heart.
This objection is faulty, however, because things like living wills are not predictions — a person in a persistent vegetative state, for example, doesn’t have preferences which could be the subject of prediction. A living will is an expression of current preferences regarding future treatment. In the absence of any later, contradictory information about new preferences, then the most recent known preferences should be accepted.
The situation is analogous to any traditional will. When you write a will, you are expressing current preferences about the future status of your estate. You aren’t predicting what your future preferences will be, because once you die, your capacity to have preferences ends. Traditional wills are accepted as having legal force and living wills should be accepted for the exact same reasons.
More difficult questions exist for cases where someone expresses preferences verbally and without the benefit of legal documents. It’s already possible for living wills to be ignored and it’s far easier for verbal preferences to be dismissed, especially by family members who disagree with those preferences. The fact that they have less legal weight, however, doesn’t mean that they carry no moral weight.
If a person expresses their preferences for how they should be treated in a hypothetical medical situation — for example, if they fall into a persistent vegetative state — then those who know about it and are responsible for the person’s treatment have strong moral obligations to heed those wishes, even if they disagree with them. People should not substitute their own ethical principles for those of another adult human being simply because they have the power and legal authority to do so. If one’s personal objections to the preferred course of action are too strong, then they should step aside and let others take over.
