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Advance Directives Advanced directives are special documents, which contain information about patients preferences and wishes as to medical care and treatment, made for the cases of inability of the patient to make medical decisions. Advanced directives are supposed to help doctors to learn, what kind of treatment every particular patient prefers, depending on the prognosis and difficulty of the situation, for example, in case of coma or permanent unconsciousness. There are two types of advance directions: direct instructive and proxy. Living will belongs to the first category: it describes the kind of medical treatment an individual would prefer in case of terminal illness (when a patient has positive prognosis for less than six month) and preferences about end-of-life care, but it does not specify a person, who will make decisions for such patient in case of his physical or mental incompetence. Advance directions of the second type, like Health Care Proxy or Durable Power of Attorney for Health Care (DPACH) identify another person, who receives the rights to make decisions for a patient in case of incapacitating medical situation.
For the last 30 years all the United States of America legalized writing and using living wills and other advance directions, granting our people the right and opportunity to control their lives and die in dignity. Recently the majority of American hospitals offer their clients, especially individuals with serious illnesses, like different types of cancer or leukemia, to fill one or a number of forms of advance directions. Therefore, sick, but still competent patients of the hospitals stipulate their desirable further treatment and specify desirable ways of medical support and involvement in critical circumstances. It is very important for everybody to write and authorize any usual type of advance directives.
Undoubtedly, as opponents of advance directives say, it is very weird and extremely hard experience to write own wishes for the cases of coma or a mental disorder, especially for seriously or terminally sick people. But every individual has to understand, that by writing own wishes and specifying the decisions in advance, in case of difficult or lethal medical conditions the right not to prolong own suffering and suffering of people around, the right to die in dignity will be fulfilled Besides, everybody must be personally responsible for own life and, till definite degree, for own death. No matter how much advanced and terminal the sickness is, an individual must not make his or her family members, close people or medical specialists of the hospital feel pressure and responsibility of making decisions in critical situations. Specifying own will and preferable approaches to further medical treatment is the way to relieve the other people form heavy burden of the necessity to decide and to rule somebody elses living and passing away. If there are reasons, which may not allow an individual to make up own mind to specify the best ways of necessary medical care, it is preferable to issue a proxy and select another person, who will be authorized to make relevant decisions in critical situations. This way it is possible to avoid misunderstandings and disagreements between close people about choosing, who exactly must be responsible for the decision making.
Otherwise, such arguments can result with fights and end up in courts, instead of concentrating on looking for opportunities to make a sick person feel better and, possibly, recover. Importance and necessity of making advance directives, either instructive, or by proxy, became obvious after huge public resonance, caused by the case of Terri Schiavo, who died less than a month ago. In 1990 she suffered large heart arrest and fell into a persistent vegetative state. Two years later her husband, Michael Schiavo, received in the court the rights to make decisions for Terri, as she did not write any living will or other advance directions. For about ten years he, together with Terri's parents, has been fighting for her recovery or at least some progress and blinks of consciousness, but there were no positive results and no positive prognosis. That is why in the end of 1990 s he announced his decision about removing Terri's feeding tube and making her pass away.
It took more than 6 years till artificial feeding was stopped, and in 2005, after 15 years of staying in vegetative condition, Terri died. For about 6 years her parents have been applying to different courts and publicly arguing with her husband about the necessity of continuing Terri's existence and her chances to be healed with modern therapies. Numerous funds and organizations supporting Terry were established, thousands of people got involved, including President Bush and Governor of Florida State, and even a special Terri's Law was ratified by the government. But in case, if Terri, who suffered bulimia and other serious health disorders much before her lethal heart arrest, would sign her living will or any advance directive, there would be no necessity of numerous courts and public observations of Schiavo family's private affairs. It is noteworthy also, that not only terminally or heavily sick people must express own will concerning medical treatment and end-of-life care. Unfortunately, any sorts of accidents and traumatic cases, sudden diseases or disorders may happen to any of us at any time and at any place.
That is why people must not think that it wont happen to me and be courageous to ensure proper medical management of possible misfortune acts by writing a living will or a health care proxy. Certainly, even if the living will requires this, it is not easy to give an order about disconnecting a family member or somebody close from life-keeping sources, and it is also not easy for medical specialists to remove feeding tubes or to stop artificial respiration. But everybody, who feels and understands social responsibility and moral duty to our community, who cares about ethical principles, about own honor and self-esteem must write an advance directive and find peace of mind without worrying for the future. Bibliography: Advanced Directives. (1999, February 22).
Ethics in Medicine. University of Washington School in Medicine. Retrieved April 17, 2005, from the World Wide Web: < web >. Advanced Directives. (2000, March 7). Cancer Information Service. National Cancer Institute.
Retrieved April 17, 2005, from the World Wide Web: < web >. Advanced Directives and Do Not Resusciate Orders. (2005, March). Family Doctor. American Academy of Family Physicians.
Retrieved April 17, 2005, from the World Wide Web: < web >. Terry Schiavo. (2005, April 14). Wikipedia. The Free Online Encyclopedia. Retrieved April 15, 2005, from < web >
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