Introduction
A. The Purposes of an Advance Directive for Medical Care.
The right to create a 'living will'
—more
accurately called an "Advance Directive for Medical Care"—
emerged
in the United States in the late 1980s and early 1990s.
This
change was a part of the larger consumer-empowerment movement.
Until
this time, most medical decisions were made by doctors
—sometimes
with input from nurses and other health-care workers.
The
patients and their families were consulted,
but
usually they just followed the "doctors' orders".
Writing a 'living will' does not mean we do not trust medical people.
But
it does recognize that we have moved beyond the point
where
one system of medical ethics
fits all patients.
Up
until the end of the 20th century,
it
was widely assumed that experts
could create a single ethical system
that
would apply to all cases that came to medical attention.
Almost
no texts of medical ethics acknowledged
that
patients and doctors might have different ethical principles.
But
along with the recognition of other forms of diversity in our culture,
we
may also realize that it might never again be possible
for
ethical experts to create one
system of medical ethics for everyone.
Medical care is a service
purchased by the consumers—the patients.
(When
we call ourselves "patients" instead of "clients"
or
"consumers", we might be disempowering ourselves.)
If
we wait patiently
long enough, we will get the treatments we need,
as
determined by the professionally-trained providers,
the
doctors, nurses, & other health-care workers.
When we create Advance Directives for Medical Care,
we
reclaim some of this decision-making authority.
Of
course, our doctors will always be
the
primary source of medical information and advice.
But
the final decisions about how to care for us must be ours.
It used to be assumed that patients had no relevant views
about
how medicine ought to be practiced.
The
doctors were considered the only experts.
People
went to the doctors to be cured,
as
they might put their cars into the hands of mechanics to be fixed.
INTRODUCTION
YOUR LAST YEAR: CREATING YOUR ADVANCE
DIRECTIVE 5
But as medical science continues to advance,
several
ways emerge to treat each problem.
And
the power to choose among these options rightly belongs
to
the person whose body and/or life is being treated.
'Informed
consent' is now a well-established medical practice.
The
patient (and/or proxies for the patient) must be informed
about
the nature of the problem and the benefits and burdens
of
each medical treatment that might be tried.
But as medical science becomes more complex,
'informed
consent' might be in danger of becoming
automatic consent to
whatever the doctors suggest.
As
patients, we are asked to sign form after form,
but
do we understand what we are signing?
The selection above is the beginning of the Introduction to
Your
Last
Year: Creating Your Own Advance Directive for Medical Care.
If you click
this title, you will see
the complete table of contents.
The table of contents tells you what else in contained in the
Introduction.
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Leonard Park—Free
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