Living Wills and Advanced Directives

Living Wills and Advanced Directives have been studied in various contexts. For example, factors that facilitate or hinder the patient's decision to complete a living will have been extensively examined (VandeCreek & Frankowski, 1996). Also, both the public and medical personnel's beliefs and opinions regarding living wills/advanced directives have been extensively researched (Singer, Choudhry & Armstrong, 1993; Waddell, Clarnette, Smith, Oldham & Kellehear, 1996).

However, what has not been much researched is the factors or variables that operate to stop compliance with a patient's requests as stated in his/her living will (Cohen, McCue, Germain & Woods, 1997). In other words, every day people are being brought to emergency rooms even though they have written requests to allow them to die in peace. Moreover, every day physicians are performing procedures on patients with living wills which request that these procedures not be performed. Clearly, if the medical and legal establishment has the intent of complying with requests stated in living wills, what is needed is a study that attempts to identify those factors that are fostering non-compliance.

The research problem of the proposed research focuses on determining those factors that contribute to noncompliance with the requests and provisions stated in a patient's living will. Several possible reasons are examined, each of which has been culled from the existing research

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d end of life decisions as stated in living wills, documented evidence on variables affecting noncompliance is sparse. However, there have been a number of articles which suggested certain factors as possibly contributory to noncompliance. The review of literature presented here discusses these articles. Factors Contributing To Non-Compliance With Living Wills/Advanced Directives Several variables have been suggested as being at least moderately contributive to the fact that family and/or medical personnel often fail to comply with patients' requests in their living wills. First, as noted by Weinstock, Leong and Silva (1994), the family and/or medical team can fail to comply with patients requests in living wills because they have doubts about the patient's competence as it relates to patient directives. In some cases, the patient may have selected a surrogate to handle matters for terminating health care, any family members or physicians are in doubt as to the competency of the surrogate. Regarding competence, Weinstock, Leong and Silva (1994) report that instances where family members or physicians are in doubt as to competence can be more frequent than most people think; this is because while states require competenc

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