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ADVANCE DIRECTIVES FOR MEDICAL CARE:
24 IMPORTANT QUESTIONS TO ANSWER

http://www.tc.umn.edu/~parkx032/CY-AD24.html

SYNOPSIS:  

     What would be the ideal way for you to die? 
If you write a careful, comprehensive Advance Directive for Medical Care,
you will be able to decide the basic pattern for the last year of your life. 
If you want your settled values to govern your terminal care, rather than standard medical practice, then you should answer these 24 Questions.  

OUTLINE:

PART I.  Scope of Your Declaration & Appointing Proxy Decision-Makers

PART II.  Quality-of-Life Issues

PART III.  Pain Control, Nursing Home, Financial Limits, & Medical Information

PART IV.  Life-Ending Decisions

PART V.  Disposition of Your Remains

PART VI.  Philosophical-Religious Beliefs & Readiness for Death

 

ADVANCE DIRECTIVES FOR MEDICAL CARE:
24 IMPORTANT QUESTIONS TO ANSWER


by James Leonard Park

    Each of us will die in some future year (maybe even this year).
Perhaps we have already created a simple 'living will' to guide the choices that must be made at the end of our lives.
But now we are ready to create a more comprehensive description of our own settled values and our own medical ethics, especially as they apply to our terminal medical care.

    This cyber-sermon consists of 24 open-ended Questions, with a brief explanation of how each might be answered.  
Only YOU can decide how you want to meet your own death.  


PART I.  Scope of Your Declaration & Appointing Proxy Decision-Makers

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?

    Most of us will make sure our Advance Directives apply to all situations
in which we are less than fully able to make our own medical choices.  

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?

    The most important element of any Advance Directive is the appointment of a person or persons (called "proxy", "agent", or "surrogate") to interpret and enforce our medical ethics as applied to our terminal care.  

3. When and how should your proxies be empowered to make medical decisions?

    Somewhere in the predictable decline of becoming mentally stressed, confused, or impaired, we should turn over to our proxies the power to make our medical decisions for us.  
If we are already losing our mental capacities, we can empower our proxies now.

PART II.  Quality-of-Life Issues

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?

    We might define our own personhood by these criteria:
(1) consciousness, (2) memory, (3) language, & (4) autonomy. 
When we have permanently lost most of these marks of personhood,
we might request our proxies to begin the process of planning for our death.

5. Where would you draw the line between a quality of life worth preserving 
and the remnants of biological life that should be mercifully shut down?

    We know of deaths that happened too soon. 
And we know of deaths that were prolonged too long.  
According to our own values, when should the plug be pulled? 

6. How do you want to be treated if you get Alzheimer's disease
or some other condition that limits your mental abilities?

    One specific kind of decline we might experience is mental deterioration. 
Just how long we should be kept alive if we become demented? 
If we lose our minds, what methods of merciful death do we approve?


PART III.  Pain Control, Nursing Home, Financial Limits, & Medical Information

7. If you are in serious pain, what do you want done?

    What do we believe about pain-controlling drugs?  
Should drugs be limited for some reason?  
Do we approve of using pain-killers
even if these drugs might shorten our lives?  

8. Do you want to be put into a nursing home? 
If so, for how long, under what conditions, & for what purposes?

    From what we have seen of nursing homes, 
what should be done in our own situation?  
Would we agree to nursing-home care as a temporary measure? 
If so, what time-limits would we choose? 

9. Where would you prefer to die?

    Many of us would prefer to die at home, 
but what impact would this have on others?  
Might it be better for us to spend our last months in a residential hospice? 

10. Will you put financial limits on your terminal care?

    Most of us will have our last year of life paid for by others. 
But even so, we might suggest a financial limit, 
so that we do not consume more than our share of medical resources.  

11. How much do you want to know about your medical condition and prognosis?

    We might choose to know little or nothing about our coming deaths. 
Or we might want to know as much as we can understand. 
Have we told our care-givers and proxies how much we want to know? 


PART IV.  Life-Ending Decisions

12. When should all curative treatments be ended?

    We know that medical science has 
an almost endless list of treatments that might be tried.
And unless we or our proxies say "enough", 
we might be treated-to-death.

13. When should Do-Not-Resuscitate orders be written for you?

    If and when we know that we are clearly on the road towards death, 
we might decide not to interrupt that journey one more time. 
For example, if our heart stops beating, 
under what conditions would we want it shocked back into action?  

14. How long should you be maintained on life-support systems?

    Medical and mechanical means exist to sustain or replace
the functions of almost all of our organs and bodily systems.  
If we are on life-supports at the end of our lives,
just when should they be discontinued or disconnected?  

15. Should food and water ever be withdrawn or withheld 
in order to shorten the process of your dying?

    We might approve in advance withdrawing or withholding 
even such simple life-supports as food and water 
if our lives are clearly coming to an end.  

16. Do you endorse more active means of ending your life? 
Do you believe you have a right-to-die? Voluntary death? Merciful Death?

    We can express our personal views about our right-to-die.  
Any such explanations will lighten the burden 
for others who must make end-of-life decisions for us.  

17. Under what conditions would you request death?

    If we have known other people who have been kept 'alive' too long, 
perhaps we can explain our own choices to draw our lives to a close
when it is certain that we will never recover.

18. Do you wish to join the One-Month-Less Club?

    If we declare our membership in the One-Month-Less Club, 
we authorize our proxies to make life-ending decisions
that will make our lives one month shorter 
than would happen under standard medical care.  

19. Which definition of death should apply to you?

    If we endorse one of the more liberal definitions of death, 
this will allow our organs to be more useful for others.  
For example, would we regard permanent unconsciousness
as a sufficient criterion for declaring us dead? 


PART V.  Disposition of Your Remains

20. Do you wish to donate your organs to other persons who need them?

    We have the right while we are still alive to arrange 
for our useable organs and tissues to be donated after our deaths.

21. Will you donate your body for use in medical science or education?

    Even if our bodies have no re-useable parts,
they can still be used for medical research 
and the education of doctors, dentists, & nurses.  

22. What other plans have you made for your remains?

    We can choose donation, burial, cremation, etc.  


PART VI.  Philosophical-Religious Beliefs & Readiness for Death

23. What philosophical, ethical, or religious beliefs do you hold 
that are relevant to your medical care and end-of-life decisions?

    Each of us has a different philosophy of life and death. 
We should explain at least the parts 
that will inform our decisions at the end of our lives.  

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 compete before you die?

    Most of us are not ready to die at this very moment.  
But we can begin now to live more reflectively
so that we will be more ready to die when we can no longer live 


drafted April 10, 2005; revised 4-18-2005: 4-24-2005; 4-2-2006; 6-15-2006; 
3-23-2009; 5-15-2009; 5-30-2009; 11-19-2010; 2-6-2011; 12-3-2011; 1-5-2012; 2-3-2012; 2-23-2012; 3-16-2012



MORE INFORMATION ABOUT ADVANCE DIRECTIVES

    Books on Advance Directives for Medical Care 
http://www.tc.umn.edu/~parkx032/B-AD.html

    If you would like to see the outline of 
James Park's book on Advance Directives, 
click this title: Your Last Year .
http://www.tc.umn.edu/%7Eparkx032/AD-OUT-NET.html
This book explains each of the 24 Questions above in much greater detail.

    Complete information about this book will be found here:
Your Last Year:
Creating Your Own Advance Directive for Medical Care
.

    These and other links will be found on the 
Advance Directives Portal

http://www.tc.umn.edu/%7Eparkx032/P-AD.html

 

AUTHOR:  

    James Park is an existential philosopher and medical ethicist.  
His own Advance Directive for Medical Care is organized around these 24 Questions: 
http://www.tc.umn.edu/~parkx032/JP-LW.html

 The above summary of Advance Directives for Medical Care
is also Chapter 28 of How to Die: Safeguards for the Right-to-Die:
"Advance Directives for Medical Care: 24 Important Questions to Answer".

Some additional cyber-sermons on related themes:

Losing the Marks of Personhood: 
Discussing Degrees of Mental Decline
 . 

The One-Month-Less Club:
Live Well Now, Omit the Last Month
 .

Choosing Your Date of Death:
How to Achieve a Timely Death
—Not too Soon, Not too Late
 .

Return to the MEDICAL ETHICS page.

Go to other cyber-sermons by James Park, 
organized into 10 subject-areas.

Return to the opening page for this website: 
An Existential Philosopher's Museum .

The views and opinions expressed in this page are strictly those of the page author.
The contents of this page have not been reviewed or approved by the University of Minnesota.
 

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