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Your Voice in the Future? The Role of Advance Directives Near the End of Life

Your Voice in the Future? The Role of Advance Directives Near the End of Life

Presented at the 2012 ABA Midyear Meeting in New Orleans, Louisiana.

Susan Shapiro, ABF Research Professor

Research presentation by Susan P. Shapiro, Research Professor at the American Bar Foundation.

The American love affair with advance directives (durable powers of attorney for health care and especially living wills) has been extraordinarily resilient over decades of disheartening experience. A recent editorial observed, “Despite the prodigious effort devoted to designing, legislating, and studying advance directives, the consensus of medical ethicists, researchers in health care services, and palliative care physicians is that the directives have been a resounding failure.”  Others write of the “death of the living will” or propose “pulling the plug” on them.  So it was with great fanfare and some relief that a recent study, published in an influential medical journal, at last affirmed our abiding faith in advance directives, touting their prevalence, efficacy, and value. Unfortunately, the study had significant flaws. What is the latest evidence on the role of advance directives in end-of-life decision-making?  This seminar draws on three years of observation in two intensive care units of health care providers and surrogate decision makers and other family and friends of patients lacking decisional capacity. The research documents how medical decisions are made day-to-day, when and how advance directives are invoked, and their impact, if any, on the decision-making process. 

The program was moderated by Doreen D. Dodson, Chair of The Fellows of the ABF and a partner at the Stole Partnership, LLP in St. Louis, Missouri.  Panelists included Dr. Dominqiue Anwar, M.D., Associate Professor of Medicine of the Palliative Care Program at Tulane University School of Medicine; The Rev. Donald P. Owens, Jr., Ph.D., the James A. Knight, M.D., Chair of Humanities and Ethics in Medicine, Associate Professor of Medicine and Psychiatry, Chaplain--Episcopal Ministrty to Medicine at Tulane University School of Medicine; and Robyn S. Shapiro, Esq., a partner at Drinker Biddle in Milwaukee Wisconsin.

The program was co-sponsored by the ABA Senior Lawyers Division, the ABA Section of Science and Technology Law, the ABA Health Law Section, the ABA Commission on Law and Aging, the ABA Special Committee on Bioethics and Law,  the ABA General Practice, Solo & Small Firm Division, the ABA Commission on Women, the ABA Commission on Sexual Orientation and Gender Identity, the Council for Racial & Ethnic Diversity in the Educational Pipeline, the National Association of Women Judges,  the Real Property, Trust, and Estate Section, the ABA Commission on Disability Rights, the ABA Section of Litigation, the ABA Commission on Hispanic Legal Rights and Responsibilities, the National Conference of Women’s Bar Associations, the National LGBT Bar Association, National Asian Pacific American Bar Association, the National Association of Women Lawyers, the Hispanic National Bar Association, the ABA Section of State and Local Government Law, the National Bar Association, and the Baton Rouge Bar Association.

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