Making advance directives meaningful

Bashing advance directives is a growth industry. Some sources doubt the practicality of the entire enterprise, involving as it does the prospective shaping of preferences regarding multitudinous possibilities in inherently unknowable post-competence situations. Other sources cite the ineffectiveness of instruction directives, relying on studies indicating that advance directives have had little or no impact on end-of-life medical care. Virtually none of these studies, and very little of the criticism directed toward advance directives, differentiates among different types of advance directives. The thesis of this article is that carefully drawn documents can be effective. The inadequacy of the advance directive mechanism to date flows from documents that are too vague and uninformative. People preparing advance directives are usually seeking to define a level of intolerable indignity at which death becomes preferable. By focusing on the elements of indignity that commonly trouble dying persons, drafters of advance directives can prepare forms that are relevant and meaningful to most people. This article examines the efforts of some existing forms to define intolerable indignity and suggests an additional approach. That additional approach is embodied in a model advance directive included as an appendix to the article

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