Thursday, March 24, 2005

from Michael Berube Online: Advance directives

I don’t know if anyone is talking about “advance directives” or “living wills” or the right to refuse life-sustaining medical treatment lately, but just in case anyone is, I thought it might help to confuse things beyond measure if I pointed out that

(a) some courts have insisted that advance directives have to be quite detailed with regard to specific levels of care and specific states of injury or illness;

(b) advance directives give courts and guardians guidelines for honoring patient autonomy– most importantly, an individual’s right to refuse treatment– but, of course, cannot account for the possibility that an individual might change his or her mind about refusing treatment after becoming ill or injured (and that such an individual might be incapable of saying so); thus, there is a possibility that the ideal of patient “autonomy” can be invoked both to honor the advance directive and to set it aside in favor of the argument that a patient’s radically changed circumstances, due to illness or injury, might have induced him or her to reassess his or her desires about treatment;

(c) the difficulties of entertaining the possibility that a person might “change her mind” about her advance directive become even more impossibly complex when the person’s mindedness is precisely what’s in question, as in cases of dementia, mental illness, or injuries and illnesses that leave a person conscious but incompetent; and

(d) adults with intellectual disabilities may not be competent to execute advance directives in the first place.

I’ll be more specific.

Once again, Prof. Berebe frames a central issue in a clear and compelling fashion. Do not assume that your basic 'this is what I want honey' conversation with your SO will be sufficient. Follow the legal requirements in your state to the letter to insure that your wishes will be obeyed. Make your living will as specific as possible. And take time explain your wishes to close friends and family who might object to your desires on religious or personal grounds.

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