What Advance Directives Cannot Do - Advance Medical Directive
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What Advance Directives Cannot Do
Advance directives were designed to help clients accomplish end-of-life medical planning. Paradoxically, advance directives may help clients avoid the real task of end-of-life planning. Executing an advance directive may create a safe, Legal fiction that the directive will accomplish the client's wishes regarding end-of-life care while the reality is far different.
There are at least four things advance directives cannot do. A directive cannot provide (cookbook- directions. Dying is just too complicated. It is individualized, personalized, sacred, profane and endlessly nuanced. A directive cannot eliminate an individual's personal ambivalence. Most clients have some level of am-bivalence for themselves and for loved ones when faced with balancing the length of life versus quality of life. Goals and wishes can and do change with passage of time and with changes in a client's medical condition, level of functioning, treatment options and quality of life.
An advance directive is a poor substitute for discussions among the client, the family and the health care professional. Effective advance planning must be a continuing conversation. The relationship between principal and proxy is a covenant, not a contract. If the client perceives the execution of an advance directive as the end point, the conversation ends. There is simply no substitute for continued communication among all the parties concerned.
Finally, an advance directive can-not control health care professionals. Whether because of a disagreement with the client's wishes, professional objection or an ambiguity in the document, a health care professional may simply overrule or ignore the client's directive or object based on conscience, an option provided in almost every state's law.
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