Decision-making and Advance Directives

by James P. Lampertius

The decision to accept or reject life-sustaining treatment has no equal. We enter this arena humbly acknowledging that neither law, medicine nor philosophy can provide a wholly satisfactory answer to this question.

To err either way has incalculable ramifications. To end the life of a patient who still derives meaning and enjoyment from life or to condemn persons to lives from which they cry out for release is nothing short of barbaric.

There is considerable tension in law and society regarding decision making on end-of-life care issues. Attempts to resolve these tensions have produced the law on what is permissible in our society (for example, in Michigan, assisted suicide is illegal). Particularly with respect to surrogate decision-making, it is extremely important that legal power and authority for decisions-making are clear; both the U.S. Supreme Court and the Michigan Supreme Court have emphasized that there must be “clear and convincing” evidence of what the patient would have wanted if able to choose for herself or himself. These statutes and court decisions are merely a baseline for authority, akin to a stoplight. They should not determine one’s ethical framework for actual decisions regarding end-of-life care.


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