Introduction
5
A. THE
PURPOSE OF
AN ADVANCE DIRECTIVE FOR MEDICAL CARE
5
1. Not Everyone Needs a 'Living
Will'. 6
2. But if You Might Disagree with Standard Medical
Care,
You Do Need a 'Living
Will'. 7
3. Going Beyond Generic Medical
Ethics. 10
4. Your
'Living
Will' Should Not Apply in Emergencies.
12
5. A Clear Advance Directive
Will Keep Your Death Simple and
Private. 13
B. PROBLEMS OF GENERIC 'LIVING WILLS' 15
C. THOUGHTLESS, IRRATIONAL, & MISINFORMED 'LIVING WILLS' 17
D. YOUR MEDICAL ETHICS 21
E. GETTING DOCTORS TO COMPLY WITH YOUR ADVANCE DIRECTIVE 27
F. PUT YOURSELF INTO YOUR ADVANCE DIRECTIVE 32
G. LAWMAKERS MAKE RIGHT-TO-DIE LEGISLATION 36
H. ADVANCE DIRECTIVE WORKSHOPS & OTHER DISCUSSIONS 37
I. FOLLOW THE FORMS PROVIDED BY YOUR
STATE
38
PART I. Scope of Your Declaration
& Appointing Proxy Decision-Makers
39
Question
1: Should Your
Advance Directive for Medical Care
apply
only when you are terminally ill or permanently
unconscious
or should it apply to all situations in which you
are not capable
of making medical decisions or are unable to express
your wishes? 39
Question
2: What person or
persons should make medical decisions
for you if you become incapable of making your own
decisions
or unable to express your wishes?
44
A. Family Members as
Proxies. 44
B. Some Family Members Might Be
Too Close Emotionally. 47
C. Two Kinds of Proxies:
For Routine
Decisions and Life-Ending Decisions.
49
D. Medical
Care
Decisions Committees (MCDCs).
51
E. Proxies for Gays and Lesbians
and other
Unconventional 'Families'.
56
F. Avoid Selecting Professionals
as Proxies. 58
G. What Will Happen If I Have No
Proxy? 60
H. Self-Appointed Medical Care
Decisions Committees. 61
Question
3: When and how
should your proxies be
empowered
to make medical decisions?
63
A. Determining Your
Capabilities. 65
1. Background for Legal
Incompetence. 66
2. Power of Doctors to Declare
Incompetence. 67
3. Some Tests of Capability to
Make Medical Decisions. 68
B. Voluntary Empowerment of Your
Proxies. 70
C. Continuing Cooperation between You and
Your Proxies. 73
D. Maintaining Your Settled Values if
You 'Change Your Mind'. 76
E. Changing Your Proxies.
77
F. When Your Proxies Might Go Beyond
Your Advance Directive. 78
PART II. Quality-of-Life Issues
81
Question
4: What level of
personhood
do you wish to preserve thru medical care?
When—according to your own criteria—
would you become a former person?
81
A. Questions for Proxies
about
Consciousness and Self-Consciousness.
82
B. Questions for Proxies about
Memory. 84
C. Questions for Proxies about Language
and Communication. 85
D. Questions for Proxies about
Autonomy. 88
Question
5: Where do you draw
the line between a quality of life
worth preserving and the remnants of biological life
that should be mercifully shut down?
94
Question
6: How do you want to
be treated
if you get Alzheimer's disease
or some other condition that limits your mental
abilities? 97
PART III. Pain Control, Nursing Home,
Financial Limits,
& Medical Information
103
Question
7: If you are in
serious pain, what do you want done?
103
Question
8: Do you want to be
put into a nursing home? If so,
for how long, under what conditions, and for what
purposes? 106
Question 9: Where would you prefer to die? 112
Question 10: Will you put financial limits on your terminal care? 113
Question
11: How much do you
want to know
about your medical condition and prognosis?
115
PART IV. Life-Ending Decisions
118
Question
12: When should all
curative treatments be ended?
118
Question
13: When should
Do-Not-Resuscitate orders
be written for you?
122
A. Avoid
Blanket
Do-Not-Resuscitate Orders.
124
B. Situations in which You Want to
Be Resuscitated. 126
1. Drug
Overdose. 126
2. Electric
Shock. 126
3. Drowning.
126
4. Blood Loss.
127
5. Diabetic
Shock. 128
C. Situations in which You Do Not
Want to Be Resuscitated. 129
1. You Are Expected to
Die. 129
2. You Cannot Tolerate Another
Resuscitation. 129
3. Resuscitation Would be
Medically Futile.
129
4. You Have a Very Low Quality of
Life. 130
5. You Are Ready for Death to
Come. 131
6. You Are Already in an
Irreversible Coma.
131
7. The Resuscitation is Dictated
by Institutional Policy
Rather than Personal
Need. 132
D. Some Special Situations for Resuscitation
Decisions. 133
1. "Slow Code"—Sham Resuscitation.
133
2. DNR as the Only Advance
Directive. 134
3. DNR in the Operating Room.
134
4. DNR in New York State —and other legislative
efforts. 135
5. DNR at Home.
137
6. Automatic DNR When Entering a Nursing Home or
Hospice. 137
Question
14: How long should
you be maintained by life-supports?
138
Question
15: Should food and
water ever be withdrawn or withheld
in order to shorten the process of your
dying?
142
Question
16: Do you endorse
more active means of ending your life?
Do you believe you have a right to die?
Voluntary death? Merciful Death?
144
Question
17: Under what
conditions would you request death?
146
Question
18: Do
you wish to join the One-Month-Less
Club? 150
Question
19: Which definition
of death should apply to you?
152
A.
Brain-Death.
153
B. Coma or Permanent
Unconsciousness.
154
C. Persistent Vegetative
State. 155
PART V. Disposition of Your Remains
158
Question
20: Do you wish to
donate your organs
to other persons who need them?
158
A. Ways of Increasing
Organ-Donation.
160
1. Reasons for Not Donating
Organs. 160
2. Changes in Law to Increase
Organ-Donation. 163
3. Financial Incentives to
Increase Organ-Donation. 166
B. Coordinating Life-Ending
Decisions with Organ-Donation. 171
Question
21: Will you donate
your body
for use in medical science or education?
174
Question
22: What other plans
have you made for your remains?
175
PART VI. Philosophical-Religious Beliefs
& Readiness for Death
175
Question
23: What
philosophical, ethical, or religious beliefs
do you hold that are relevant
to your medical care and other end-of-life decisions?
175
Question
24: Are you ready to
die now? If yes, explain.
If no, what preparations (practical, interpersonal,
spiritual)
would make you more ready to die?
What projects do you wish to complete before you die?
181
PART VII. State Forms, Supportive Statements, & Appendices
182
A. INTEGRATING
YOUR
'LIVING WILL' INTO STANDARD FORMATS
182
B. GETTING COOPERATION FROM YOUR DOCTORS
184
C. GETTING COOPERATION FROM YOUR
HOSPITAL 187
D. GETTING STATEMENTS OF COOPERATION FROM YOUR
PROXIES 188
E. DOCUMENTING THE PROCESS OF CREATING YOUR 'LIVING
WILL' 189
F. REVIEWING AND REVISING YOUR 'LIVING WILL'
PERIODICALLY 190
G. DISTRIBUTING COPIES OF YOUR ADVANCE
DIRECTIVE 191
James
Park’s
Advance Directive for Medical Care
195
revised 3-23-2009; 1-30-2018;
If you would like more information about this book, go to:
Your
Last Year:
Creating Your Own Advance Directive for Medical Care
by James Park.
Return to the MEDICAL ETHICS page.
If you would like to see how the author answers the 24 Questions
himself,
click here for James
Park's
Advance Directive.
If you would like to read other books about Advance Directives,
click here for Books
on Advance
Directives for Medical Care.
Go to
the beginning of this website
James
Leonard Park—Free
Library