Here is a true story that illustrates how some comments made by a family member may help in the end of life medical decisions even when there is no written advance directive or a living will.
Mary (not real name) is 93 years old with mild dementia and heart disease with severe peripheral vascular disease. She is able to converse with her family about what she wants to eat, how she is feeling and whether she needs pain medicine or not. She does not understand the severity of her problems and is unable to make her own medical decisions and thus the family members are making all the decisions for her. She has mild contractures of her legs and lies in bed most of the time, but is able to get up with help.
Mary is admitted to the hospital with painful foot which has gangrene in two of the toes of her left foot. She also has signs of infection and is being treated with antibiotics. Doctors recommend amputation of the left leg below the knee to get rid of the gangrene and prolong her life. Family is asked to make a decision for her therapy.
Family members next meet with the Palliative Care Team (author included) to discuss options and see what would be the right thing to do for the patient. Mary does not have an advance directive or a living will and family says that they never had any end of life discussions with her. In further talking with them about the kind of life she wanted to lead, they do remember her always saying, "I never want to lie a bed of affliction."
With the help of this comment, the family later was able to decide not to have any surgery which may have given her a longer life but she would be definitely "lying in a bed of affliction".
Instead they opted to enroll her in hospice, keep her comfortable as long as God wished her to be here.
Family was at peace with their decision since they felt it followed her voiced wishes.