Ethical Wills: Creating Meaning at the End of Life

Abstract

Ethical wills require understanding the unique individuality of the person. This approach focuses on the intangibles as well as the tangibles of one’s inheritance. It provides for the passing on of one’s values, beliefs, heuristic learning, and feelings of love, forgiveness, and hope for the future. This approach allows the individual to live on in the hearts and memories of those who knew him or her. A caring tradition that stems from Genesis 49 is being revived and brought to life today.

Leaving a lasting legacy: A scoping review of ethical wills

“…Multiple articles noted that ethical wills are often created during or around a transition or milestone for the writer (e.g., birth of a child or grandchild, wedding, retirement, anticipating the end of life) (Baines, 2003; Pagano, 2006; Williams et al, 2010; Kaslow and Benjamin, 2015; Martin, 2015; Ziff, 2016; Tugend, 2020). Only 53% ( n = 27) of the articles mentioned the timing of when to share the ethical will; of these, 63% recommended sharing while alive and 37% noted that writers may wish to share after death.…”

“…It should not be controlling but is meant to be an influential document which can be used by the recipients as a form of guidance to help them navigate the rest of their lives. It can also foster intergenerational connection (Baines, 2003; Alexander, 2006; Shultz, 2006; Gaudiani, 2007; Cohen-Mansfield et al, 2009; Kaslow and Benjamin, 2015). Thus, generativity is a central component of ethical will creation.…”

“…Comprehensive palliative assessment explores the patient's spiritual and existential views of their meaning and purpose in life, spiritual beliefs and practices, relationships, concerns or fears of quality of life or death and dying, and life completion tasks (National Consensus Project for Quality Palliative Care, 2018), which could be addressed through ethical will creation. Through this review, we identified 14 articles that discussed using the ethical will to address mortality or attitudes about death, which indicate that reflecting on meaning in life and articulating values may provide the writer a sense of life completion (Barnes et al, 1997; Wheeler and Farnsworth, 2000; Baines, 2003, 2004; Cole and Kloberdanz, 2003; Frank, 2003; Gessert et al, 2004; Alexander, 2006; Shultz, 2006; Hicks, 2008; Falkner, 2009; Williams et al, 2010; Martin, 2015; Grewe, 2017). The Dying in America report recommends patients, families, and providers prepare for death by having conversations throughout the life cycle, not just near the end of life (Pizzo, 2016).…”

“…Third, ethical will creation is a self-directed exercise anyone can complete independently without assistance from a trained member of the healthcare team or a specific number of sessions, making it accessible to a wide audience with a flexible timeline of completion. The process of writing an ethical will is not a prescriptive intervention and may be unstructured or prompted by questions to allow the creator to write from the heart (Baines, 2003).…”

“…The Institute of Medicine recognizes the need for improvement in end-of-life care, including increasing clinicians’ awareness that patients and families may have existential and spiritual concerns in addition to the need for clinical care (Institute of Medicine, 2015). Ethical wills have been proposed as a way for clinicians to positively influence end-of-life planning and discussions through holistically addressing the needs of patients (Baines, 2003; Brown, 2007; Cohen-Mansfield et al, 2009; Martin, 2015) recommends clinicians (1) be educated on the value of leaving a legacy and the impact communicating it can have on patients and their families and (2) participate in self-reflection about their own legacy in order to be able to discuss ethical will creation with patients. The fact that ethical will creation does not need to be facilitated by a trained professional expands the opportunity for it to be used in a number of scenarios and increases access for its use among the broader population, not only to patients nearing the end of life.…”