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From The CriticsReviewer: David Thomasma, PhD(Loyola University Medical Center)
Description: Nancy King's book is a second edition of the best single book in field of advance directives.
Purpose: Physicians often have difficulty "making sense" of advance directives. King's chapters follow the reasons why. They range from worries about the competency of patients who made advance directives, and their current understanding or their surrogate's understanding of the medical situation, to the practicalities of both developing the directives and applying them later. The author argues that advance directives are not so much legal documents as expressions of patient's values. They do not therefore close a discussion with caregivers, but rather contribute to it, now conducted with their proxies.
Audience: Like others in the series on Clinical Medical Ethics, it is intended for clinicians, but it is also useful for laypersons who wish to craft the best possible advance directives with their physicians and ensure their implementation when they cannot provide current preferences. King's book is also intended for anyone who wishes to develop a set of advance guidelines about their care for physicians. The layperson will therefore find this book helpful as well. Members of ethics committees, bioethicists, and those in charge of hospital policy will also use this practical but thoughtful book.
Features: The revision of the original is occasioned by rapid developments in the law, court cases, and critical thinking in ethics about the problems of family or surrogate decision making, patient autonomy, and medical futility. Clarifications of advance directives are accompanied by case examples. Too, the cases underline her central point that advance directives should and even must contribute to a discussion that is embodied in shared decision making. Second, there is an updated bibliography accompanied by a listing from Choice in Dying of all Federal and State Statutes. Third, included is a current listing of relevant court cases that bear upon the questions of patient decision making, advance directives, and medical futility.
Assessment: My only criticism of this revision is that it does not discuss the variations of laws about advance directives from state to state or offer a major comparison of various legislative efforts. King assumes an informed physician and patient will know the law in one's own state in any event. Advance directives are both personal and communal. This sensible approach to advance directives eliminates the over-reliance on legalities and their use as trump cards in a game of power that is often conducted at the bedside of very ill incompetent patients.