sistent with their own clinical judgment. The physicians indicated that they wanted to reserve the right to make clinical judgments about treatment regardless of a client's request. In another study, Docker (1995) reported on a study where 900 patients were studied over a period of ten years. In very few cases did advance directives have any influence over decisions to withdraw or withhold life prolonging treatment. The passage of the PSDA half way through the study changed their effectiveness by barely one percent. A study conducted in the state of Utah, among 1398 participants, found little evidence that advance directives affect life sustaining treatments (Jacobson, Kasworm, Baltin, Francis, Green, 1996). Jaffe and Ehrlich (1997) report "unfortunately, the advance directive movement has not had great success . . . breakdowns occur with alarming frequency in the chain of responsibility to observe them" (p. 145). When clients were transferred from ambulatory to acute care settings, only 26 percent of the clients who had advance directives had them recognized by the admitting hospital (Jaffe & Ehrlich, p. 143). These statistics command our attention. They also make us focus on the tension and disagreement that exists between physicians and their clients. The population clearly seeks more control over both their future medical care and also the method, timing, and place of their death. Patients want ". . assurance that there will be no unreasonable efforts, an affirmation that the dignity to be sought in death is the appreciation by others of what one has been in life. . . the acceptance of one's own death is a necessary process of nature . . ." (Nuland, 1993, p. 255). Yet these statistics show that physicians often do not allow clients control. How disheartening for a person to fear that the doctor cannot be trusted in a matter of such importance. It appears that many doctors have no respect for their clients' wis...
