THE VALUE OF ADVANCE DIRECTIVES

In the preceding chapter it was noted that advance directives can serve several important values. They can preserve well-being by protecting the individual from intrusive and futile medical interventions; they can promote self-determination; and they can serve as vehicles for altruism by authorizing termination of treatment that would impose financial or emotional costs on others. Nevertheless, weighty objections have been raised against advance directives, and a more probing analysis of their moral authority is warranted.

THE MORAL AUTHORITY OF ADVANCE DIRECTIVES

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.

It was argued in Chapter 2 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 decisions. First, even if at the time an advance directive was issued an individual was well informed about the options available should he or 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.