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Oliver Stone

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Advances in medical technology have done a great deal to produce miraculous cures and recoveries. In some circumstances however, these advances have created problems for the elderly. More aggressive technology approaches are used to extend the life of the elderly. On the whole the elderly, as well as others, welcome that development even if they fear some of its consequences. With these advances it has become possible to keep people in a vegetative state for almost unlimited periods of time. Moreover, there are situations in which neither the patient nor the family has the ability to bring such unhappy circumstances to an end.

For this reason, advance directives are becoming increasingly prevalent. Advance directives are like living wills. They are documents that a person can complete to ensure that health care choices are respected. An advance directive only comes into play if a person cannot communicate wishes because the person is permanently unconscious or mentally incapacitated. A 1991 law called The Patient Self Determination Act (PSDA) requires hospitals and nursing homes to tell patients about their right to refuse medical treatment. People can put anything in their advance directives.

Some people list every medical intervention they do not want, while others want to make clear their request for heroic measures at any cost. It is a way to spell out personal wishes. Advance directives are seen as a way to protect one's legal rights for refusal of treatment. But are advance directives effective in achieving the aim intended? There is evidence both on the Internet, in case study books and magazines to indicate that

advance directives alone fall far short of their objective. In very few cases did advance directives have any influence over decisions to withdraw or withhold life prolonging treatment.

The statistics in recent studies demand our attention and make us focus on the tension and disagreement that exists between physicians and their patients. The population clearly seeks more control over both their future medical care and also the method, timing, and place of their death. Yet, if one were to really study the publicized statistics, he or she would find that physicians often do not allow patient control. How disheartening for a patient to fear that the doctor cannot be trusted in a matter of such importance. It appears that many doctors, nurses, especially manor care takers, have no respect for their patients' wishes. Nurses as patient advocates have a responsibility to make sure patients' wishes are respected; it is nursing's role to raise informed questions and even objections if a patient's treatment violates the patient's wishes.

Without strenuous interventions to improve the situation, a vast effort will be put forth to establish something that basically doesn't work. Evaluations of the reasons for the failure to implement a patient's advance directive would show quite a dramatic grab of attention. When families contradict the patients wishes, physicians take their views under consideration giving them immense weight. After all, who does the physician have to answer to? The living, of course. This is why when the family disagrees with the advance directive, the family's decisions usually win out. Dealing with death and suffering on a

daily basis does not make it easy for medical professionals



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