Wednesday, June 12, 2013

Living Wills revisited

Dick Thaler's proposal of a mandatory living will (see here) has received some attention (HT by Peter Ubel who wrote in Forbes on "Is Behavioral Economics the Death of Living Wills?"

He starts with
As a physician who conducts research on decision-making, I have been asked many times: What does behavioral economics teach us about the role of living wills in medical care?

Give someone a complicated choice, with lots of trade-offs, and Thaler could fill the semester explaining how and why that decision is likely to go wrong. Indeed, early developers of the living will went to elaborate lengths to create documents that describe the exact situations patients might encounter in the future. [..] No one familiar with the problem of “choice overload” could believe that reflection on so many possible futures, and some impossible choices, would somehow capture people’s true preferences.

To make matters worse, the trade-offs relevant to most living wills involve powerfully emotional and often strikingly unfamiliar choices. People must imagine what life is like with dementia or metastatic cancer or kidney failure. A slew of studies, including a number I have collaborated on with George Loewenstein and Dylan Smith, have shown that people are notoriously bad at predicting what life will be like with these health conditions. We don’t always know what we will want in our futures. My paternal grandmother said she would rather be dead than live in a nursing home, and then enjoyed her time in the nursing home so much after she moved in that she wondered what took us so long to find her a room there.

He then proposes a solution

Everyone should make sure they’re comfortable about who will make decisions for them if they are unable to decide for themselves.

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