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2(d). Living Will declarants do not give up comfort care

A person who chooses not to have futile life-sustaining treatments does not give up all treatment. It is the goal of the treatment that changes, "from curing to caring". The patient not only still has the right to receive comfort care and treatment to relieve pain, but in fact comfort becomes the primary goal. As a practical matter, too many patients do not receive adequate treatment for pain, but that is true whether or not they have executed advance health care directives. The issue of under-treated pain is discussed in another section of this article.

Some people are concerned that if they sign a document stating that they do not want futile treatment, the medical team will "give up too soon". To the contrary, in our experience it is more likely that doctors and nurses will "wait too long" rather than "give up too soon". Medical professionals are trained from the outset to preserve life. It is not only an ethical duty but a source of professional pride to do everything possible toward that end. It is very hard, as it should be, for them to acknowledge that further treatment can only prolong a hopeless situation.

We think the more realistic fear is of receiving inadequate pain relief. This comes not from unkindness but from a combination of unawareness and the complications of a rather clumsy health care system. The issue of under-treated pain is dicussed in another section of this article, but the existence of the problem is a good reason for appointing a proxy, if one is available. The proxy should be someone who can and will be assertive in demnading that his/her loved one be allowed to pass this life as peacefully and comfortably as possible.

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