For and against advance directives

An essay by Carol Levine in today’s New York Times (She Died the Same Way She Lived: Planning Well in Advance) counters those who oppose advanced directives. Her mother died of colon cancer at 90 and was comforted that her end-of-life instructions were followed. The author lists some of the arguments being made against advanced directives by the President’s Council on Bioethics:

[N]o one can foretell the precise circumstances in which end-of-life decisions will be made. Furthermore, advance directives are often not transmitted to hospitals and doctors. Finally, even when they are available advance directives have little effect on surrogate decision making.

The author rejects these criticisms based on her mother’s experience. I think they can be rejected in broader terms as well.

  • It’s true no one knows what the exact end-of-life circumstances will be. But the value of an advance directive is not realized only at the end. There’s value to a healthy person in the peace of mind of having their wishes documented and known
  • One of the few compelling rationales for a patient-populated personal health record (PHR) is to transmit advance directives. It’s true that advance directives are often not transmitted to hospitals and doctors, but that’ something that we can change
  • Advance directives have more effect on surrogate decision making than not having any instructions, and they provide reassurance and guidance to responsible caregivers
December 6, 2005

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