The Clinical Realities of Advance Directives
![handle is hein.journals/wlsj17 and id is 441 raw text is: THE CLINICAL REALITIES OF ADVANCE DIRECTIVES
DONNA A. CASEY'
D A ID M. WALKER
'The choice between life and death is a deep .peronal decision of obvious and overwhelming
jinaztji'.
I. INTRODUCTlION
Advances in modern medicine are capable of delaying the dying process for
weeks, months, or years, and frequently involve diminished quality of life and
significant pain and suffering.2 Despite such advances, most individuals fear
the dying process more than death itself and, as such, are reticent to discuss
either.3 This fear includes dying in a hospital or nursing home with tubes,
wires and drains, or suffering pain and humiliation.4 Some individuals,
however, overcome this fear; they engage in conversations about death and
the dying process.5 Some of these individuals even find hope in legal
documentation, i.e. advance directives. While the concept of advance
directives is noble in its efforts to prevent 'bad deaths,' the clinical reality of
these documents falls far short of nirvana.6
* BSN, ALk, RN, FABC, NE BC, Nurse Manager, Wilmington IHospital Intensive
Care Unit, Co-Chair, I thics Committee, Christiana Care Health System, Wilmington, Delaware.
** J.D. 2011, \Xidcner University School of Law.
1. Cruzan v. Mo. Dep't of Health, 497 U.S. 261, 281 (1990).
2. See I mil Clough, A Critique ofAdvance Directives and Adance Directives Legislation, 11
APPEAL REV. CURRENI L. & L. Ruh'wOi\i 16, 20 21 (2006); Joseph T. Monahan & Elizabeth A.
Lawhom, Life Sustainin g Treatment and the Law: The Evolution of Informed Consent, Advance Directives
and Surrogate Deision MFaking, 19 ANNNis H,,\ITH 1. 107, 107 (2009-2010); Ben Kusmin, Note,
Swing Low Sweet Chariot Abandoning the Disinterested U1itness Requirement for Advance Directives, 32
AL. J.L. & MED. 93, 93 (2006).
3. See Ira R. Byock, Foreword: The American Consciousness Regarding the End of Life to
Elisabeth Belmont et al., A Guide to Legal Issues in Life Limiting Conditions, 38 J. IIEA iii L. 145,
147 (2005); Karcn Anne Meehan, Advance Directives: The Clinical \urse Speialist as a Change Agent,
23 CTNEc,\T NURSE SPF CI\TIST 258, 259 (2009); Lauren Vogel, Advance Directives: Obstacles in
Prepaingfor the Worst, 183 CAN. MED. ASS'N J. at E39, E40 (2011).
4. Clough, supra note 2, at 18. Furthermore, [p]eoplc fcarcd 'the prospect of dying
away from home in impersonal and unfamiliar surroundings and of having to endure prolonged
and often needless suffering.' Id. at 20 21 (quoting GEALD D\\ ORKIN ET AL., Eu IIANASIA
AND PllYSICIAN ASSISTED SU1IDE 84 (1998)). For a perspective on patients implementing
advance directives out of fear that physicians will make treatment choices for them, see Theresa
S. Drought ct al., Advance Directives: Changing Our Expectations, 110 CIIEST 589, 589 (1996),
available athttp: //chestjournal chcstpubs. org/contcnt/110/ 3 /589. full. pdf+ htnl.
5. For a discussion of the approximate number of individuals who implement
advance directives, see Kusmin, supra note 2. See also Byock, supra note 3, at 147 151; (lough,
supra note 2.
6. Susan Brink, Living Wills Often Ignored, NSNB(C.CoM (eb. 26, 2010, 6:13 lN),
http: //www.msnbc.com/id/ 35610499 /ns/hcatlh hcath-carc/.
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