When Sallie Morton had a stroke two years ago, relatives began taking care of her in her home. She was able to swallow soft foods but unable to move her right side or speak, and her family suspected she was not aware of their presence. Recently she was hospitalized with a severe urinary infection, and her kidneys eventually stopped functioning. The family and her doctor then faced a decision: While it was possible to manage her kidney failure with dialysis, should it be done?
The dilemma presented them not so much with a medical question as a value question. There is general consensus in our society that the standard the physician and family should use in such cases is not what they would choose for themselves, but what the patient him-or herself would choose. Assuming that the response is within the range of morally acceptable options, how can family members and physicians follow the wishes of a patient who is unable to talk? How might the family of Sallie Morton have learned whether she would have wanted to remain in her current condition a few more months or years, or go to be with the Lord?
While discussion among family members is the most important answer, over the past 15 years, specialists in medicine, ethics, and law have also developed documents that let individuals express to their families and physicians their wishes about treatment should they lose decision-making capacity. Collectively these documents are called advance directives. Although they may take many forms, advance directives are of basically two types: those that detail what types of treatments the person would or would not want under certain conditions, and those that name a proxy decision maker, sometimes also called a surrogate.1
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