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JOHN OF LAURA

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His living will his wishes for a couple of black and white situations to express: he did not want to be kept alive if He was terminally ill, or in an irreversible vegetative state. But the situation I was not so easy before. The neurologist said that he would wake up from a coma, but there was a good chance he would have severe brain damage. How much of a chance? The doctors could not say.

doctors and nurses say that is my heart-wrenching experience typical of the complexity of the real decisions at the bedside. An estimated 25% to 30% of Americans have living wills, documents indicate, completed the requirements for a medical treatment. But ethicists say that are not usually simple documents, the solution many hoped it would be. Life-prolonging medical technology has far surpassed by physicians ability to predict outcomes. The most difficult decisions on the center, if the quality of life decreases, so that death is preferable.

As such, some health organizations are trying to improve living wills and provides more flexibility and nuance. Some ethicists, meanwhile, the emphasis on living wills as a whole and focusing on the appointment of a trusted family member or friend than your health care agent.

?Most of us have concluded that the way to get over the vagueness, get someone to talk to you, come,? says Robert M. Veatch on, professor of medical ethics Georgetown University Kennedy Institute of Ethics in Washington, DC

advance directives were established in the 1960s and gained national attention in the 1970s as a young woman, Karen Ann Quinlan, for alcohol and drug use at a party , was left in a vegetative state, raising alarms about the medical people on life in hopeless cases.

?We had a naive view that if you have a document that would solve the problem,? says Daniel Callahan, co-founder and president emeritus of the Hastings Center, a Garrison, NY, nonprofit that early advocate of the patients was available. ?In practice,? he says, ?all kinds of problems? that are not written in the documents. Paul Shalline

As an active 86-year-old who regularly exceeded his grandchildren at table tennis, unable able to communicate after a massive stroke March occurred, treatment decisions for his daughter, Robin. Ms. Shalline, a 57-year-old teacher from Monkton, Vermont, says her father had a living will, but never talked with her about his wishes. ?There?s so much gray area,? she says. ?You would hope that the living will would spell out everything, but it does not work.?

His life for withdrawing life-sustaining support when it is called no reasonable expectation of recovery of a ?meaningful quality of life?, but does not describe what that meant, she says. Ms. Shalline when the doctors to be their father, in one eye, unable to feed themselves and may never walk again blind could tell, made the decision to withdraw ventilator based on ?what I know about his life knew. ? Mr. Shalline, loved the Wiffle ball, and had recently helped build a stairway, was ?proud of its? physicality ?,? she says. He died 18th Of March.

It?s hard enough to do under the best circumstances, what would your family want in a particular situation. But that is the fact that you even top doctors can not predict results very well.

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Lee H. sponge, deputy chairman of the department of neurology at Massachusetts General Hospital in Boston, where Mr. Shalline was treated, says that even if he thinks he can be the outcome of patients after a stroke predict, he is wrong in 15% to 20% of the time, the most important endpoints, such as whether a patient is able to walk again. ?I?ve never seen a living will, and I?ve seen this a lot, speaks on the issue of diagnostic uncertainty,? says Dr. sponge.

living documents?

p You get a living will with a lawyer or download it from the Internet. Many focus on permanent coma and clearly hopeless conditions. Florida law proposed, living will, for example, leads to stop life-prolonging treatments if there is ?no reasonable medical probability? of recovery from a terminal condition or persistent vegetative state are. Florida, like most states allow you to want to write your own life, and some states, like New Hampshire set, that advance directives have a state-approved form to be used. (A bill is now in New Hampshire as the state form would be optional.)

A number of efforts have been made to improve the living standard of style. A document available online from Life Care Guidelines LLC, Las Vegas, for example, multiple levels of cognitive abilities from a coma spells to mental ?confusion,? the 24-hour care need, and asks if you would life support will, if Do not use your brain as much. The document also gives you an option to say whether doctors as ?positive proof?, ?highly specific? or ?quite sure? that you never recover before pulling the plug. ?/ P>

want is a simpler, but also innovative approach to the popular Five Wishes living will. Five wishes for a sixth-seventh-class is written, says Paul Malley, president of aging with dignity, a nonprofit that distributes the document. Despite its simplicity, the five wishes living solves many other problems One asked, for example, if you want pain medication to relieve suffering, even if it makes you sleepy. It also has a blank spot where the man a state in which they would not be kept alive.

You can specify are

?Some people have a phrase that pops into your head are:?. When I?m in the same condition as Aunt Mary, ??says Mr. Malley Originally written in 1997, the is five wishes was available online in an interactive format since last year.

interpretation open

In a 400-patient study published in 2001, Dr. Fagerlin and colleagues found that family members who were presented with nine hypothetical scenarios correctly predicted patient desires about 70% of the time, whether the patient had filled a living.

? you do not need to complete such documents Mr. Callahan, who championed living wills in their early days, he says not one, but more power of decision to give his wife, to whom he said simply: ?When in doubt do not treat. ?

A health-care agent a trusted family member, for example, might-the need to displace a living will. Under the legal doctrine of? substituted judgment, ?try health agents have the decision you would if you might say, Alan Meisel, director of the Center for Bioethics and Health Law at the University of Pittsburgh. all-a phone call, a list of instructions or a formal living will, be used as evidence of your wishes, he adds.

for my father, we moved the decision is made, and he woke up, sharp as a pin, capable of making his own decisions.

Miss John is a writer in Boston . She can be reached at next@wsj.com.

Corrections & Amplifications
The Five Wishes advance directive was originally written in 1997. A earlier version of this article incorrectly said the year was 1987 .

A version of this article appeared June 11, 2012, on page R5 in the U.S. edition of the Wall Street Journal, entitled: A New Look at Living Wills

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