Prevention & Wellness

sslivingwill_374355691_optThe Importance of a Living Will

Despite its name, a living will isn’t at all like the wills that people use to leave property at their death. A living will, also called an advance healthcare directive, advance directive or medical directive, is “a written statement detailing a person’s desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive,” according to one dictionary.

In short, says, a living will “explains whether or not you want to be kept on life support if you become terminally ill and will die shortly without life support – or [if you] fall into a persistent vegetative state.”

For some, the concept is a little gruesome and, frankly, frightening, but few deny the value of addressing questions that may arise from a terminal illness, an injury or permanent unconsciousness.

The document is not limited to questions of life and death. It also can answer questions about someone’s personal preferences as regards, for example, to tube feeding, artificial hydration and pain medication, and usually applies when someone cannot communicate their desires on their own.

Without a living will, doctors or hospitals may feel legally bound to perform procedures that a patient or patient’s family might not want. A living will obviates the conflict, articulating a patient’s desires in such circumstances.

Staff at the Mayo Clinic, writing on, explain that “advance directives guide choices for doctors and caregivers if you’re terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.

“By planning ahead,” they write, “you can get the medical care you want, avoid unnecessary suffering and relieve caregivers of decision-making burdens during moments of crisis or grief. You also help reduce confusion or disagreement about the choices you would want people to make on your behalf.”

Importantly, they note that living wills “aren’t just for older adults. Unexpected end-of-life situations can happen at any age, so it’s important for all adults to prepare these documents.”

No legislation in Cayman

In Cayman, advance directives have emerged only in the last couple of years amid both legal and ethical discussion. Julene Banks, an attorney and a member of the Cayman Islands Mental Health Commission, has sat on the Ethics Committee of the Health Services Authority, and says she has prepared at least five – and witnessed others – as part of estate planning packages during 2014 and 2015.

The agreements were concluded after family consultations, Ms. Banks says.

“Two families lost their loved one,” she says. In one of the cases, the client “was able to communicate his final wishes,” while, in the other “the designated executor was able to assist and be the voice. No court action was needed for either.

“The important thing,” Ms. Banks says, is “to keep the lines of family communication open and mediate any conflict before a crisis occurs.” She concedes, however, “this can be very emotional and hard for families to deal with.”

Calling it a “timely subject,” she says no formal decisions have been made and Cayman has no legislation regarding living wills, although “discretionary powers of the Grand Court may apply.”

Amanda Roberts, chair of the HSA’s Ethics Committee, describes the implications of living wills in light of the lack of legal standing in Cayman.

“It means that if, for example, you have a ‘DNR’ [a “do not resuscitate” order], and you collapse … it’s not a legal document, and while it may be taped to the refrigerator in your kitchen, the ambulance people are still under a legal obligation to resuscitate.”

Similarly, the prevailing sentiment in large Caymanian families is often to “keep mama alive” at all costs and as long as possible, often meaning that she is airlifted to Miami for “a miracle cure.” Sadly, Ms. Roberts says, she may end up dying there instead of comfortably at home.

Ms. Roberts says she has not created living wills herself, but has seen an informal “Letter of Wishes” detailing preferences for end-of-life treatment. But, like a living will, the letter has no legal standing.

Like so much else in Cayman, making legislative progress is a matter of political will and even broad social consensus, and she has seen some small progress in standardizing DNRs.

Ms. Banks says she includes living wills in conversations about estate planning “and I encourage discussions with family members and executors.”