Making Decisions Today For Health Care Tomorow
Today, 80-85% of Americans die in medical institutions. Of those, 70% require decisions about whether to apply, withhold, or withdraw medical treatment (Makar 58). Due to this ever increasing number, the right to die is one of the most popular and controversial topics in medicine today. The issue comes down to personal beliefs and ethics and the fact that there is so little clear-cut legislation on this topic confuses it even more. Advance Directives provide, in theory, for self-determination and put the patients mind at ease with the knowledge that they have decided for themselves the extent of health care that they wish to receive. Also, for the family, the process of watching their loved one suffer through unwanted medical treatment is eliminated. In practice, however, there are a lot of inconsistencies and legal barriers that place limits on their usefulness.
Some would argue that there is a limit to the amount of self-determination a patient retains even with an advance directive. They would say that a part of self-determination is that the patient makes an active, mental decision about his/her health care, and that advance directives dont fulfill this requirement. Regardless, it is clear that it is better than having no voice whatsoever in the decision. Also, in regard to attitudes toward self-determination today, many people waive this right either because they dont know that they have a choice or because they feel that they dont have a right to question a doctor or make medical decisions themselves (report Abram et al. 49-50).
Alan Lieberson, author of the Living Will Handbook, describes a progression that our society has taken that has led to the necessity of advance directives. This is that since our society places a very high value on human life, it is becoming more and more important to preserve life, even when the quality of life is decreasing. Prolongation of a patients life started to reflect on the physicians ability. The relationship between this and huge advances in medical technology in the 1960s that introduced new machines that could be used to temporarily restore health led to several problems. One is that these machines began to be put to use even in cases where there was no hope of recovering with the previous quality of life. Second, even physicians who didnt want to use these machines sort of got trapped into using them in emergencies, when it was unclear what the outlook for the patient was. Once the machines are hooked up, it is difficult for legal reasons to get them turned off (Lieberson 27). In this way advance directives are economically wise because they eliminate a lot of unwanted, but previously unavoidable expensive health care (report, Abram et al. 56-57).
In 1976, California passed the first living will act. The legislators felt that for terminally ill patients, the loss of dignity and the amount of pain and suffering that they...