my english is horrible and nowhere close to being able to analyze this text, if you could take a quick peak for me and let me know what exactly i should be looking for i would be grateful
'text below i know its a wall of text but u dont have to read it if you dont want to.
2) What are the differences between the contemporaneous choice of a competent individual and the issuance of an advance directive to cover future decisions?
Those who have shown unreserved enthusiasm for the use of advance directives
have perhaps made the following assumption: if, as the courts and
most bioethicists now agree, the competent individual has a virtually unlimited
right to refuse treatment, even life-sustaining treatment, then the
same choice ought to be respected when a competent individual makes it
concerning a future decision situation through the use of an advance directive.
I have argued elsewhere that this assumption is dubious because it
overlooks several morally significant asymmetries between the contemporaneous
choice of a competent individual and the issuance of an advance
directive to cover future decision^.^
For example, even if at the time
an advance directive was issued an individual was well informed about the
options available should she develop a particular disease or be in a certain
condition, therapeutic options and hence prognosis may change between
the time the directive was issued and the time at which it is to be implemented.
A second morally relevant difference is that the assumption that
a competent person is the best judge of her own interests is weakened in
the case of a choice about future contingencies under conditions in which
those interests have changed in radical and unforeseen ways.
A third and equally significant asymmetry is that important informal
safeguards that tend to restrain imprudent or unreasonable contemporaneous
choices are not likely to be present, or if present, to be as effective,
in the case of an advance directive. If a competent patient refuses life-sustaining
treatment, those responsible for her care can and often do urge the
patient to reconsider her choice, and in some cases this can prevent a precipitous
and disastrous decision. This safeguard, if it occurs at all, is unlikely
to come into play as forcefully during the process of drawing up an
advance directive. For when the decision to forgo life-sustaining treatment
is a remote and abstract possibihty it is less likely to elicit the same
protective responses that are provoked in family members and health care
professionals when they are actually confronted with a human being who
they believe can lead a meaningful life but who chooses to die.
Once these three asymmetries are appreciated, it should be clear that
even if the competent patient has a virtually unlimited right to refuse lifesustaining
treatment, it does not immediately follow that a refusal of lifesupport
ought always to be respected if it is expressed in an advance directive.
After more complex argumentation, however, we might well conclude
that in spite of these asymmetries the law ought to regard valid advance
directive.^ as having the same force as a competent patient's
contemporaneous choice. For we might be persuaded that attempts to
limit the authority of advance directives would in practice lead to their
being ignored by paternalistic physicians or families, thus robbing them
of their value. The well-documented persistence of unjustified paternalistic
behavior by physicians indicates that this is a significant danger.3
This post was edited by ImoK on Mar 10 2014 03:30pm