Taking Advance Directives Seriously: Prospective Autonomy and Decisions Near the End of Life

In the quarter century since the landmark Karen Ann Quinlan case, an ethical, legal, and societal consensus supporting patients' rights to refuse life-sustaining treatment has become a cornerstone of bioethics. Patients now legally can write advance directives to govern their treatment decisions at a time of future incapacity, yet in clinical practice their wishes often are ignored.

Examining the tension between incompetent patients' prior wishes and their current best interests as well as other challenges to advance directives, Robert S. Olick offers a comprehensive argument for favoring advance instructions during the dying process. He clarifies widespread confusion about the moral and legal weight of advance directives, and he prescribes changes in law, policy, and practice that would not only ensure that directives count in the care of the dying but also would define narrow instances when directives should not be followed. Olick also presents and develops an original theory of prospective autonomy that recasts and strengthens patient and family control.

While focusing largely on philosophical issues the book devotes substantial attention to legal and policy questions and includes case studies throughout. An important resource for medical ethicists, lawyers, physicians, nurses, health care professionals, and patients' rights advocates, it champions the practical, ethical, and humane duty of taking advance directives seriously where it matters most-at the bedside of dying patients.

Robert S. Olick is associate professor in the Center for Bioethics and Humanities, SUNY Upstate Medical University. He formerly served as executive director of the New Jersey Bioethics Commission, where he was a principal author and legislative architect of that state's advance directives law. Dr. Olick is coauthor of the book, The Stored Tissue Issue: Biomedical Research, Ethics, and Law in the Era of Genomic Medicine (2004).