Letter: Effects of 'living wills' on doctors, carers and the law

Sir: The introduction of 'living wills' ('Doctors welcome 'will' covering terminal illness', 8 September) is a sad reflection of society's fear of the doctor's power to intervene in the course of a terminal illness.

'Living wills' have been used in some parts of the United States, where medical practice has a tendency to be more interventionist than in Britain, particularly with regard to continuing life-sustaining treatment in a terminal illness.

They have serious limitations; they may ignore the possibility of an individual patient changing his mind. Clinical experience shows that patients with incurable cancer and other life-threatening illnesses may make different choices from those made when they were healthy.

'Living wills' are no substitute for good communication between a doctor and a patient. If patients were given the time and the opportunity to discuss their fears and to make their own free choices about their treatment, there would be no need for them.

The presence of a 'living will' may be of some help in influencing a doctor's decision in the special situation when a patient is unable to communicate . However, to encourage the widespread use of legally enforced 'living wills' could damage the doctor-patient relationship and impair the quality of care of patients with terminal illness.

Yours sincerely,

DAVID JEFFREY

St Richard's Hospice

Worcester

8 September