A FOR LIFE-ENDING DECISIONS
ADVANCE DIRECTIVE FOR MEDICAL CARE
When making life-ending decisions, the most
(or former person) to consider is the individual whose life is ending.
Our deaths belong to us more deeply than anything else we can own.
Thus the first death-planning document must
come from ourselves.
We are the ones who will either go on experiencing life
or draw our
lives to a close.
And when we consider our lives at any given moment,
we usually decide that we want to continue living.
But there might come a time when we decide
that the burdens of
continuing to live are greater than
the benefits we or
others derive from our continued existence.
All of us should formulate our philosophies of
living and dying
while we are still in good health and able to think clearly.
And we should put our decisions about life and death into 'living
—better called "Advance Directives for Medical Care".
The most complete Advance Directive will address
such matters as:
appointing good proxies, decline of quality of life, levels of
medical costs, nursing-home placement, & ideal pathways towards
Explore all dimensions of comprehensive
Advance Directives here:
Once we have created at least a good draft
of our Advance Directive for Medical Care,
we should share it with others who will be affected by our decisions.
Then at least those family members and friends who will be our proxies
should be asked to create their
own statements of support,
expressing their willingness to carry forward our settled values
if and when we are no longer able to make medical decisions
or to express our own wishes.
And in the context of life-ending decisions,
such statements of support should explicitly address
the question of whether the family members and/or the proxies
support the patient's medical ethics explained in the Advance
When several family members or proxies have the same
they can all sign the same statement of understanding and support.
But it would be better for each person to write an individual
In some cases, a circle of friends and relatives
will be serving on the Medical
Decisions Committees of one another.
This will encourage all to be serious about their own Advance Directives
and to consider carefully how they will participate in the deaths of
HOW AN ADVANCE DIRECTIVE
WILL DISCOURAGE IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
Because irrational suicide is often impulsive and
the very process of preparing an Advance Directive for Medical Care
will help the patient who is inclined toward killing himself
to consider carefully all of the alternative pathways towards death.
He or she will consider the settled values that are worth preserving
as well as the burdens of life that sometimes make is easy to say,
"Stop the world, I want to get off!"
When an Advance Directive explicitly defines in
the patient's ideal pathway
then relatives who want to get rid of the patient
will not be able to rationalize their own harmful aims
by saying that the patient wanted to die anyway.
An Advance Directive prevents
by stating as fully as possible beforehand
under what circumstances the patient
would want to live
and under what conditions death
would be a better choice.
Also an Advance Directive will select the best
persons who are best able to carry forward the
And any relatives whose motives might be suspect will be excluded
the decision-making process by not being selected
Thus the death chosen will be at
the best time and by
the best means
—selected by the patient, not by someone who might have different
And if the proxies and others write their
own supportive statements,
such involvement will help to ensure wise end-of-life decisions.
These significant others will be attuned to the moods of the
if this patient has any suicidal tendencies,
any irrational urges to kill himself or herself will likely be noticed
by the family members who are discussing
which conditions would lead to the decision to continue living
and which conditions would lead the patient to choose death.
And if there is any danger of irrational suicide,
these close family members and friends can do their best
to discourage the patient from killing himself or herself.
An irrational suicide is harmful
to the patient,
even if the patient wanted to die at that moment.
And an irrational suicide will seem tragic and regrettable
to all family and friends who go on living.
This circle of people will be discussing
pathway towards death as selected by the patient.
When they agree on the appropriate time and place for death,
they will also be acknowledging other times and places
where the death would be inappropriate
Sometimes the close family members will be best able to uncover
death-planning that would lead to a premature death
it would really be best for the patient.
When others participate in planning for death,
a wiser decision is likely to emerge: not too soon and not too
The people who are closest to the patient
can help the patient select the best
2007; revised 1-26-2008;
2-5-2010; 5-9-2010; 9-9-2010; 5-21-2011;
expanded to include statements from
which used to be a separate
safeguard SG-AD-SP 1-4-2012;
1-28-2012; 2-22-2012: 3-22-2012;
8-1-2012; 8-19-2012; 11-14-2012;
5-22-2013; 6-26-2013; 7-23-2014;
5-6-2015; 1-7-2016; 11-22-2017;