Resurrecting Terri Schiavo : the advance directive in modern America

In recent years developments in life sustaining technologies have made it possible to expand a patient’s life without necessarily extending a corresponding quality of life. The decision to employ or forego life sustaining treatment should ultimately be made by the patient under the cherished ideal of patient autonomy. This is, however, extremely problematic in the advent of patient incapacitation throughout the course of a terminal illness, due to mental incapacitation, or owing to an unforeseen Persistent Vegetative State (PVS). Without an advance directive an incapacitated patient is left in a precarious situation of dependence upon others with respect to decisions regarding end of life care. The only way to guarantee the preservation of patient autonomy, while preventing the socio-economic costs incurred from unwanted and costly treatment, is through the promotion of advance directives. Advance directives can be in the form of a living will or medical proxy. A patient may also choose to supplement these with a Do Not Resuscitate Order (DNR). New York State has piloted and legalized a new, cutting edge format for advance directives: Medical Orders for Life Sustaining Treatments (MOLST). I propose that legislation requiring physicians to discuss MOLST with patients would provide patients with the medically relevant information required to make decisions regarding their own life sustaining treatment preferences. I suggest that the government is obligated by the principle of patient autonomy to push the public forward towards universal adoption of advance directives