What are Advanced DirectivesAdvance directives, also known as living wills, and health care proxys are documents that a person can complete to ensure that health care choices are respected. An advance directive only comes into play if a person cannot communicate wishes because the person is permanently unconscious or mentally incapacitated. A 1991 law called The Patient Self Determination Act (PSDA) requires hospitals and nursing homes to tell clients about their right to refuse medical treatment. People can put anything in their advance directives. Some people list every medical intervention they do not want, while others want to make clear their request for heroic measures at any cost. It is a way to spell out personal wishes. It is crucial that the issue of advance directives and the issue of euthanasia not be confused. These issues couldn't be more dissimilar. Euthanasia is largely illegal. Advance directives are seen as a way to protect one's legal rights for refusal of treatment. But are advance directives effective in achieving the aim intended? Advanced Directives Fall ShortThere is evidence to indicate that advance directives alone fall far short of their objective. In a recent study conducted at Harvard Medical School, Fishback (1996) reported 66% of all physicians interviewed felt there was nothing wrong with overriding a patient's advance directive, even if the directive unambiguously stated the conditions for the withdraw and withholding of medical treatment. Fishback also reported 40% of the physicians questioned chose a level of care different from that requested in advance by clients who subsequently became incompetent. The physicians interviewed indicated that they would only follow a client's advance directive if it was con...
