|
"They couldn't hit an elephant at this dis..."
General Sedgwick (d. 1864) during a Civil War battle
as he looked out over a parapet toward the enemy.
Quoted in Jones, Clarence,
The Complete Book of Death and Dying.
New York: Harper Collins. 1997
This quote serves as a reminder. Accurate assessment of the facts can be important.
Most people complete directives because they hope for a "peaceful death."
The expression "peaceful death" is borrowed from Daniel Callahan’s
thoughtful book The Troubled Dream of Life.
No one can be guaranteed a peaceful death. Dr.Callahan suggests that it probably is a
bad idea for anyone to believe that they must achieve complete control over the manner of
their dying. However, the forms and guidance available from this site are intended to help
you increase your chances of experiencing a peaceful death.
The forms that most people use are often
very brief statutory forms. If you are interested, please read why we do not recommend statutory forms.
There are other reasons for completing advance health care directives besides
addressing end-of-life concerns. One is avoiding an unnecessary guardianship. Another is
having someone of your choosing oversee your health care during any period of
incapacity, not just at the end of life.
The effectiveness of advance directives in controlling health care treatment decision
making has been overstated . Thus, it is important to understand the limitations as well
as the benefits of advance health care directives.
Do not assume that an advance directive guarantees that your treatment wishes will
be followed.
For a number of reasons, advance directives are not always effective. Achieving
your goals in health care at the end of life usually depends more on your relationship
with your physician than it does on anything else. The ability of your agent to act as
your advocate and the support of your family can also prove to be critical.
Many if not most people will die having never completed advance directives. That is the
way it has been and probably will continue to be. Death in the absence of directives does
not mean that unwanted life-prolongation is inevitable. However, clear and specific
directives may help when conflicts over values and "who is in charge" conspire
to prevent a peaceful death.
Do not expect legal documents to transform the behavior of physicians and other health
care professionals who are trained and socialized to make war on death. Do not assume that
your physician will be particularly interested in reading your advance directives. (If her
experience has been that directives are typically too vague to be of much help, why should
she?)
Well-written directives can help an agent deal with a physician who disagrees with your
treatment instructions. They may be of little value to an agent whose determination
evaporates in the presence of a physician’s authority.
One perverse consequence of the recent emphasis on passing.advance directive laws is
the assumption that life-sustaining treatment cannot be forgone if there is no advance
directive. While nothing could be further from the truth, it is best to avoid this
argument by completing your directives.
Completing directive forms is no substitute for taking measures to deal with potential
family conflicts over your care should your become incapacitated.
Finally, completing directives may not enable you to bypass the potentially troubling
process of confronting your own mortality.
More about why directives sometimes fail Additional
discussion of the search for a peaceful death and more on why
advanced directives sometimes fail.
None of these caveats about directives should discourage you from completing yours.
We address the limitations of advance directives here, in part, to counter the
promotion the mindless signing of forms. That is, completing directive forms with little
thought, reflection, and discussion. While we would encourage people to use our forms
rather than the ambiguous and limited Arizona statutory forms, we especially want to
caution against "mindless" completion of forms.
Next...
Step 2: Select your health care agent(s) Please read
this next page even if you do not plan to appoint an agent.
* return to top of page * return to Overview * disclaimer
* home |