Making Sense of Advance Directives: Revised Edition

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Georgetown University Press, Feb 1, 1996 - Medical - 304 pages
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Advance directives—such as living wills and health care proxies—are documents intended to declare and preserve the health care choices of patients if they become unable to make their own decisions. This book provides a comprehensive overview of advance directives and clear, practical directions for writing and interpreting them.

Nancy M.P. King provides a legal, philosophical, and historical analysis of the moral and legal force of advance directives. She explains the types and models of advance directives currently in use and offers guidelines for individuals seeking to write, read, and use directives to promote individuals' health care choices within the laws of their own states.

King emphasizes that advance directives are not orders given by patients to their doctors; instead, they are documents that invite conversation between doctors and patients about health care decisions of great importance. The purpose of advance directives is to support patients' health care choices, and the book promotes a thoughtful use of advance directives that is best calculated to achieve that purpose, whatever form individual advance directives may take.

This new edition has been updated to reflect the many changes in advance directive statutes since 1991, including expanded discussions of health care proxy statutes, the impact of the Patient Self-Determination Act and the Supreme Court's Cruzan decision. King also has extended her analysis of the implications for advance directives of managed care, resource allocation, resource scarcity, and the debate over futile treatment at the end of life.

Making Sense of Advance Directives is a valuable handbook for patients, health care providers and administrators, patient counselors, lawyers, policymakers, and any individual interested in advance directives.

 

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Contents

Introduction
1
MAKING SENSE OF ADVANCE DIRECTIVES
3
EASY CASES HARD CASES AND ADVANCE DIRECTIVES IN PERSPECTIVE
8
FIVE MODELS OF ADVANCE DIRECTIVES
16
ADVANCE DIRECTIVES IN CONTEXT
33
Treatment Refusal and the Patients Choice Foundations in History Law and Ethics
37
TECHNOLOGY AND TREATMENT REFUSAL
39
THE NATURE AND HISTORY OF INFORMED CONSENT
43
COMBINING THE FORMS
140
A PATIENT PROXY OFFICE?
141
A SAMPLE OF STATES
142
READING DIRECTIVES
180
Directions for Decision When Documents Dont Do It All
184
THE CONTEXT OF MEDICAL CHOICES
185
SUBSTITUTED JUDGMENT
189
THE NEW BEST INTERESTS
194

AUTONOMY VERSUS BENEFICENCE
51
DECISIONAL CAPACITY OR THE COMPETENCE CONUNDRUM
69
The Future Factor The Conceptual Foundations of Advance Directives
76
APPRECIATING THE FUTURE FACTOR
77
IMPROVING AWARENESS OF THE FUTURE FACTOR
80
PERSONAL IDENTITY AND ADVANCE DIRECTIVES
81
THE CONTINUITY OF A LIFE
84
OTHERS OBLIGATIONS REGARDING DIRECTIVES
90
EMERGENCIES OPPORTUNITIES AND THE QUALITY OF LIFE
97
REASONS OR JUSTIFICATIONS?
100
ADVANCE DIRECTIVES IN THE IDEAL WORLD
103
Advance Directives Current Forms Legal Fears Moral Goals
108
WHAT CAN A DOCUMENT DO?
111
ADVANCE DIRECTIVES AS LEGAL DOCUMENTS
113
NONCONFORMING DIRECTIVES
114
IMPLEMENTING DIRECTIVES
118
LEGAL MORAL BOTH OR NEITHER?
121
STATUTORY ADVANCE DIRECTIVES
124
LIVING WILLS
126
DURABLE POWERS OF ATTORNEY FOR HEALTH CARE
132
MOTHERS DAY SYNDROME AND OTHER FAMILY PROBLEMS
199
THE PROCESS OF DECISION
202
INTERPRETING AND IMPLEMENTING ADVANCE DIRECTIVES
203
INTERPRETING REVOCATION
204
REVOCATION AND THE FUTURE FACTOR
209
CONCLUSION
213
The Forecast for Advance Directives Indispensable or Superfluous?
215
ADVANCE DIRECTIVES AND MORAL COMMUNITIES
216
ARE DIRECTIVES COST CONTAINERS?
218
REQUEST DIRECTIVES
221
MEDICAL JUDGMENT AND ADVANCE DIRECTIVES
225
THE ASCENDANCE OF FUTILITY
227
THE IMPACT OF SCARCITY AND COST
229
MAKING ADVANCE DIRECTIVES MAKE SENSE
233
Advance Directive Statutes StatebyState and Federal Listings
239
Notes
245
Bibliography
265
Index
279
Copyright

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About the author (1996)

Nancy M.P. King is a lawyer and an professor in the Department of Social Medicine at the University of North Carolina at Chapel Hill.

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