The problem is that 80% or more of persons who execute "advance directives" revoke them when they are sick (i.e., they change their minds). If people under 40 all made advance directives, this number would be 95%+.
Therefore, respecting someone's "wishes" without regard to the clinical scenario is incompetent at best, if not negligent.
It is not obvious that brain-injured persons (who cannot "change their mind") should be held to the letter of their "prior wishes", since those prior wishes in expressive patients have almost no substance.
I don’t think it’s incompetent or negligent, but you’re right. That’s why I mentioned making our wishes known, probably better stated as explaining the reasons underlying your decision on an ongoing basis, enabling the proper decision to be made. For example, I’d have little doubt what decision to make for an observant Jew or Catholic, who’s explained the religious basis for his decision to maintain nutrition. That's not likely to change. Someone who made a decision ten years ago based on “who wants to live like that” and never revisited the issue, you’re right, their decision might not be clear.
National Right to Life - WILL TO LIVE
Did you know that, even if you are coherent and change your mind about having "life support" (which can be interpreted any way states wish .. even food and water) removed, the medical staff can still proceed with "allowing" you to die, because you signed a living will .. which focuses on when to let you die instead of FIRST doing everything medically possible to save your life?
Therefore, respecting someone's "wishes" without regard to the clinical scenario is incompetent at best, if not negligent.
It is not obvious that brain-injured persons (who cannot "change their mind") should be held to the letter of their "prior wishes", since those prior wishes in expressive patients have almost no substance.
Very good, very important post.