The Family Fortress Estate Planning Blog reported on an LA Times article which in turn reported on a study conducted on the effectiveness of living wills, also known as advance directives.  The conclusion espoused by both the blog and the Times report seems to be that having a living will increased the chances that your wishes will be honored.  But as I read both pieces I kept asking myself the question that is asked in the editorial reporting the study.  As the Times article quotes, the editors noted : "whether the preferences of patients were any more likely to be honored if they had a living will than if they did not -- cannot be determined from this study." 

So, the conclusion is that you can't conclude anything about the effectiveness of living wills from this study.  Yes, when a living will requested limited care, such as no artificial life support, this was honored 83% of the time.  When a living will requested comfort care, i.e. keep me free from pain, it was honored 97% of the time.  But the study doesn't seem to have a control group.  In other words, there are no statistics for how many patients got limited care or comfort care when they didn't have a living will.  What I think is telling is what happened when the living will requested aggressive care, i.e. "Do whatever can be done".  When the patient requested more than limited care, half of the time those wishes were not honored.   But the number who wanted aggressive care was only ten while the number seeking limited care was 398.  So it seems that the vast majority of people don't want aggressive care and they don't get it -- there's no real evidence that the living will made a difference in the kind of care they received.

I tell clients and families that living wills aren't very enforceable as legal documents.  If your living will requests no life support and your loved ones instruct the doctors to continue life support, there really isn't going to be anyone willing to sue the doctor for keeping you alive.  What I think living wills do is give comfort to the family members and confidence to the doctors that they are carrying out your wishes.  The process of making a living will also gives you an opportunity to contemplate your legacy and discuss these important end-of-life issues with your family.  I don't need a study to confirm that.