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November 25, 1983

The Living Will

Author Affiliations

Queens Hospital Center Affiliation of the Long Island Jewish-Hillside Medical Center Jamaica, NY

JAMA. 1983;250(20):2789. doi:10.1001/jama.1983.03340200023010

To the Editor.—  The excellent article by Eisendrath and Jonsen (1983; 249:2054) and the accompanying editorial (1983;249:2073) point out only some of the ethical issues involved in the living will. There are many others.Since it is extremely difficult to prognosticate accurately for critically ill patients and to determine whether the patient is irreversibly ill and whether death is imminent, the provisions of the living will may be activated prematurely. Alternatively, the existence of a living will may deprive the patient of the full efforts of the medical team who might not use the usual vigor and aggressive approach dictated by the patient's condition.If the patient changes his mind during the period when the living will is in effect yet fails to rescind the declaration formally, it may be activated without proper "informed consent." Heroic measures or "extraordinary treatment" is difficult to define precisely. What was heroic a few