Making Sense of Advance Directives: revised edition

by Nancy M.P. King

Overview

Advance directives—such as living wills and health care proxies—are documents intended to declare and preserve the health care choices of patients if they become unable to make their own decisions. This book provides a comprehensive overview of advance directives and clear, practical directions for writing and interpreting them.

Nancy M.P. King provides a legal, philosophical, and historical analysis of the moral and legal force of advance directives. She explains the types and models of advance directives currently in use and offers guidelines for individuals seeking to write, read, and use directives to promote individuals' health care choices within the laws of their own states.

King emphasizes that advance directives are not orders given by patients to their doctors; instead, they are documents that invite conversation between doctors and patients about health care decisions of great importance. The purpose of advance directives is to support patients' health care choices, and the book promotes a thoughtful use of advance directives that is best calculated to achieve that purpose, whatever form individual advance directives may take.

This new edition has been updated to reflect the many changes in advance directive statutes since 1991, including expanded discussions of health care proxy statutes, the impact of the Patient Self-Determination Act and the Supreme Court's Cruzan decision. King also has extended her analysis of the implications for advance directives of managed care, resource allocation, resource scarcity, and the debate over futile treatment at the end of life.

Making Sense of Advance Directives is a valuable handbook for patients, health care providers and administrators, patient counselors, lawyers, policymakers, and any individual interested in advance directives.

Product Details

ISBN-13:	9780878406050
Publisher:	Georgetown University Press
Publication date:	02/01/1996
Series:	Clinical Medical Ethics series
Edition description:	revised edition
Pages:	304
Product dimensions:	6.00(w) x 9.00(h) x 0.65(d)
Age Range:	18 Years

About the Author

Nancy M.P. King is a lawyer and an professor in the Department of Social Medicine at the University of North Carolina at Chapel Hill.

What People are Saying About This

Medical Humanities Review - Chris Hackler

"The book is directed primarily at clinician . . . [and] is also accessible to intelligent readers generally. It can provide help to individuals as they develop or revise their own directives, and it can aid administrators and institutional ethics committees as they struggle with policy and procedural issues . . . the best single book on this timely topic."

Editorial Reviews

The book is directed primarily at clinician . . . [and] is also accessible to intelligent readers generally. It can provide help to individuals as they develop or revise their own directives, and it can aid administrators and institutional ethics committees as they struggle with policy and procedural issues . . . the best single book on this timely topic.

Medical Humanities Review

Reviewer: David Thomasma, PhD (Loyola University Medical Center)
Description: Nancy King's book is a second edition of the best single book in field of advance directives.
Purpose: Physicians often have difficulty "making sense" of advance directives. King's chapters follow the reasons why. They range from worries about the competency of patients who made advance directives, and their current understanding or their surrogate's understanding of the medical situation, to the practicalities of both developing the directives and applying them later. The author argues that advance directives are not so much legal documents as expressions of patient's values. They do not therefore close a discussion with caregivers, but rather contribute to it, now conducted with their proxies.
Audience: Like others in the series on Clinical Medical Ethics, it is intended for clinicians, but it is also useful for laypersons who wish to craft the best possible advance directives with their physicians and ensure their implementation when they cannot provide current preferences. King's book is also intended for anyone who wishes to develop a set of advance guidelines about their care for physicians. The layperson will therefore find this book helpful as well. Members of ethics committees, bioethicists, and those in charge of hospital policy will also use this practical but thoughtful book.
Features: The revision of the original is occasioned by rapid developments in the law, court cases, and critical thinking in ethics about the problems of family or surrogate decision making, patient autonomy, and medical futility. Clarifications of advance directives are accompanied by case examples. Too, the cases underline her central point that advance directives should and even must contribute to a discussion that is embodied in shared decision making. Second, there is an updated bibliography accompanied by a listing from Choice in Dying of all Federal and State Statutes. Third, included is a current listing of relevant court cases that bear upon the questions of patient decision making, advance directives, and medical futility.
Assessment: My only criticism of this revision is that it does not discuss the variations of laws about advance directives from state to state or offer a major comparison of various legislative efforts. King assumes an informed physician and patient will know the law in one's own state in any event. Advance directives are both personal and communal. This sensible approach to advance directives eliminates the over-reliance on legalities and their use as trump cards in a game of power that is often conducted at the bedside of very ill incompetent patients.

Doody's Review Service

4 Stars! from Doody

Nancy King's book is a second edition of the best single book in field of advance directives. Physicians often have difficulty "making sense" of advance directives. King's chapters follow the reasons why. They range from worries about the competency of patients who made advance directives, and their current understanding or their surrogate's understanding of the medical situation, to the practicalities of both developing the directives and applying them later. The author argues that advance directives are not so much legal documents as expressions of patient's values. They do not therefore close a discussion with caregivers, but rather contribute to it, now conducted with their proxies. Like others in the series on Clinical Medical Ethics, it is intended for clinicians, but it is also useful for laypersons who wish to craft the best possible advance directives with their physicians and ensure their implementation when they cannot provide current preferences. King's book is also intended for anyone who wishes to develop a set of advance guidelines about their care for physicians. The layperson will therefore find this book helpful as well. Members of ethics committees, bioethicists, and those in charge of hospital policy will also use this practical but thoughtful book. The revision of the original is occasioned by rapid developments in the law, court cases, and critical thinking in ethics about the problems of family or surrogate decision making, patient autonomy, and medical futility. Clarifications of advance directives are accompanied by case examples. Too, the cases underline her central point that advance directives should and even must contribute to a discussion that isembodied in shared decision making. Second, there is an updated bibliography accompanied by a listing from Choice in Dying of all Federal and State Statutes. Third, included is a current listing of relevant court cases that bear upon the questions of patient decision making, advance directives, and medical futility. My only criticism of this revision is that it does not discuss the variations of laws about advance directives from state to state or offer a major comparison of various legislative efforts. King assumes an informed physician and patient will know the law in one's own state in any event. Advance directives are both personal and communal. This sensible approach to advance directives eliminates the over-reliance on legalities and their use as trump cards in a game of power that is often conducted at the bedside of very ill incompetent patients.

David Thomasma

This revised edition coincidentally arrives in a flurry of media attention regarding "right to die" issues, and provides sound advice to both clinicians and patients in the legal and moral aspects of advance directives, more commonly known as living wills and health care proxies. King explains the types and models of advance directives currently in use, offers guidelines and examples in writing, reading, and promoting directives. She distinguishes between different state laws, illuminating some of the objections raised against compliance. Annotation c. Book News, Inc., Portland, OR (booknews.com)

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