The living will. Help or hindrance?

The living will is a statement that directs physicians to act in certain ways during a patient's terminal phase of illness. The physician is instructed not to take measures that would prolong the life of the patient. The living will is designed to promote patient autonomy while removing onerous decision making from physicians and the patients' families. Experience with the living will indicates that it can either help or hinder clinical decision making. When appropriately implemented, the living will can perform its intended functions. When vague in terminology or applied to patients with uncertain prognoses, the living will can promote medical staff confusion. Adequate communication between patient and physician can improve the utility of the living will. Other considerations affecting the applications of the living will are discussed in detail.