Advance Directives Research Paper

This past Tuesday, I attended Dr. Eric Vogelstein’s philosophical seminar and forum titled “Advance Directives: Problems and Prospects.” This talk focused upon the use of advance directives, which can be described as written legal documents that detail a patient’s wishes regarding their medical treatments in the case that he or she unable to verbalize them due being in an unforeseen medical state or circumstance, as well as the implications of their use in the medical field. Advance directives themselves usually consist of living wills medical powers of attorney (i.e. proxy designation). The use of advance directives is often ethically justified based on the belief that it allows patients to exercise their autonomy through self-determination.

Thus, the purpose Dr. Vogelstein’s discussion was to examine whether such ethical justification can be considered as valid by analyzing three specific practical problems, the function of advanced directives, and their use in cases with patients suffering from Alzheimer’s disease and dementia. However, in this reflection I will only address the three arguments raised in this talk.
The first argument presented against the use of advanced directives revolved around the issue of informed consent or more specifically the lack of informed consent.

It is argued that advanced directives do not actually allow patients to exercise true autonomy since these documents can be constructed without adequate discussion with a healthcare professional, which is an underlying characteristic the widely accepted definition of informed consent. In my opinion, this lack of communication between a patient and healthcare professional about creating an advanced directive is potentially disastrous and does not allow a patient to utilize self-determination. Without this essential discussion with a healthcare professional, who is assumed to be knowledgeable in possible health outcomes, treatments, and interventions, it can be said that patients are not able to obtain and utilize all present information available to them in order to make efficient decisions about their health. Thus, a patient is unable to effectively construct an advanced directive that truly details their wishes and values regarding their treatment. At first sight, it appears that advanced directives provide a patient with full control regarding their desire future course of treatment without knowledge of all information, which is primarily gained from thorough discussion with a healthcare professional, it is unlikely that he or she is able to truly exercise their autonomy regarding their future

health.
The problem of translation was also presented as an argument against advanced directives since such documents are unable to fully describe the complexities associated with decision-making and the possible choices available in specific medical situations.

I believe that this argument is valid because it is a well-known fact the very nature of medicine is highly unpredictable and complex. As humans, we tend view future scenarios with outcomes that we hope to occur or predict will occur. However, combining this human tendency for favorable predictions with advanced directives can lead to disastrous effects for a patient since he or she may not see the true reality of the complexity of a possible future medical circumstance. For example, if a patient documented his or her wish to be resuscitated only by the means of CPR in the event of being unresponsive, the patient could fail to see the possibility that this method may not be efficient or that other methods, such as cardiac defibrillation, may be a quicker and more convenient method to save their life. Thus, the use advanced directives may play a role in closing patients off to the examining and comprehending the complexity of medical interventions by confining them to their preferred and sometimes misguided wishes. Such an example also illustrates the last argument presented in talk which focused upon the belief that we has humans do not actually know what we want. Hence it is difficult for us as humans to definitively make

choices for future events because we are prone to either underestimate or overestimate our inclinations towards things. A patient currently wish to be given life sustaining treatment even if he or she is medically vegetative because of person values and may include such directions in an advanced directive, but this patient may not hold the same values in the ensuing months and wish for this intervention to take place. Overall, the use of advanced directive at first glances appears to be a useful tool for solving difficult treatment decisions that align with a patient’s wishes, but it clear that their use highlights a number of ethical issues as well as discrepancies in human nature itself.