Modern medicine has put a new twist on one of our most fundamental values . . . self-determination. A patient's right to self-determination becomes a poignant and volatile issue in the context of modern life-sustaining technologies. When the benefit of medical treatment is overshadowed by the resulting burdens, treatment may ethically be withdrawn. Patients have the right to make this decision, assuming they still have the capacity to make it. Through advance directives a competent patient can extend his right to consent to or refuse medical treatment indefinitely into the future. Whether in the form of informal oral instructions or formal written documents, advance directives insure patients that their treatment wishes will be carried out. They also alleviate the uncertainty, guilt, and/or fear of legal consequences facing the family and caregivers. This volume is a collection of fourteen essays investigating the advantages and disadvantages of different kinds of directives, the role of professionals in making and honoring them, policy issues that need to be addressed, and future directions which directives may take. Although such documents may be used to request treatment, this volume limits its focus to their more common function . . . the refusal of treatment. Timely and comprehensive, Advance Directives in Medicine provides a stimulating overview of this relevant topic.
The papers in this volume were originally presented at a multidisciplinary conference on advance directives. Revised and edited for this text, they address a variety of questions and issues, for instance: What are the individual and societal benefits of advance directives? Does an advance directive tamper with the sanctity of life? Will normalizing directives have an adverse effect on the practice of medicine? Should a patient specify treatments to be withheld within a directive, such as the use of CPR, nutrition, or hydration? What legal sanctions should apply against those who ignore directives? Should directives be used to reduce health care expenditures by insurance companies, Medicare, and Medicaid? What is a physician's role in helping his patient formulate an appropriate directive and when is a patient ready to confront his own mortality?
About the Author
CHRIS HACKLER is Head of the Division of Medical Humanities at the University of Arkansas for Medical Sciences.
RAY MOSELEY is Director of the Medical Humanities Program, University of Florida College of Medicine.
DOROTHY VAWTER is Research Associate at the Center for Biomedical Ethics, University of Minnesota Health Center.
Table of Contents
Introduction: Advance Directives--An Overview
Advance Directives in Medicine: Choosing Among the Alternatives by John C. Moskop
Interpreting Proxy Directives: Clinical Decision-Making and the Durable Power of Attorney for Health Care by Eric T. Juengst and Carol J. Weil
Living Will Statutes: Good Public Policy? by W.D. White
A Framework for Legal Analysis of Advance Directives in Health Care by Robert B. Leflar
Do Living Will Statutes Embody a Claim Right or a Mere Privilige to Refuse Life-Prolonging Treatment? by William Soderberg
The Financial Enforcement of Living Wills: Putting Teeth into Natural Death Statutes by Michael A. Rieand H. Tristram Engelhardt, Jr.
Advance Directives and Health Care for the Elderly by David C. Thomasma
Advance Directives and the Physician: Talking with Healthy Patients About Dying by John Harding
Talking with Patients About Advance Directives: The Role of the Primary Care Physician by Kent Davidson and Ray Moseley
Advance Directives and the Denial of Death: Should the Conflict be Resolved? by Stuart J. Youngner
Advance Directives and the Right to be Left Alone by H. Tristram Engelhardt, Jr.
Advance Directives, Self-Determination, and Personal Identity by Rebecca S. Dresser
Advance Directives: Beyond Respect for Freedom by John Churchill
Literary Analogues to the Living Will by Howard Carter
Information and Publications Concerning Advance Directives