Taking Advance Directives Seriously

Prospective Autonomy and Decisions Near the End of Life

Robert S. Olick

"An important resource for health-care professionals, medical ethicists, and legal scholars who are involved in the legal rights and policy issues surrounding end-of-life decisions."
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In the quarter century since the landmark Karen Ann Quinlan case, an ethical, legal, and societal consensus supporting patients' rights to refuse life-sustaining treatment has become a cornerstone of bioethics. Patients now legally can write advance directives to govern their treatment decisions at a time of future incapacity, yet in clinical practice their wishes often are ignored.

Examining the tension between incompetent patients' prior wishes and their current best interests as well as other challenges to advance directives, Robert S. Olick offers a comprehensive argument for favoring advance instructions during the dying process. He clarifies widespread confusion about the moral and legal weight of advance directives, and he prescribes changes in law, policy, and practice that would not only ensure that directives count in the care of the dying but also would define narrow instances when directives should not be followed. Olick also presents and develops an original theory of prospective autonomy that recasts and strengthens patient and family control.

While focusing largely on philosophical issues the book devotes substantial attention to legal and policy questions and includes case studies throughout. An important resource for medical ethicists, lawyers, physicians, nurses, health care professionals, and patients' rights advocates, it champions the practical, ethical, and humane duty of taking advance directives seriously where it matters most-at the bedside of dying patients.

Table of Contents



1. The Place of Prospective Autonomy in Deciding for Incompetent Patients

2. The Ethical Foundations of Prospective Autonomy

3. Prospective Decisional Autonomy

4. The Problem of Personal Identity

5. Respecting Advance Directives: Putting Theory into Practice




"This book will be an important resource for physicians, medical ethicists, and other health care professionals as they deal with the rights and prerogatives of the dying and the legal and policy questions surrounding the choices to be made in the conduct of their care."—New Jersey Medicine

"Disquieted that the wishes of dying patients do not direct care at the end of life even when their intentions and plans have been put to writing in an advance directive, Olick rethinks and reinvigorates the case for patient and family control in the face of significant challenges to the nature, scope, and importance of autonomy in the care of incompetent dying patients."—Book News, Inc.

"I recommend this book highly to all health care professionals. It is clearly written, and beautifully argued. It was a pleasure to read such lucid prose reflecting clear thinking. It certainly gave a me a different perspective from which to argue for the rights of patients to die in a dignified manner, a topic that is important to all of us, health care professional or not."—Nursing Ethics

"The book is simultaneously a model of scholarship and a work of advocacy that if heeded would dramatically change the way many patients die. Highly recommended for upper-division undergraduate and graduate students and faculty, and essential reading for professionals and practitioners."—Choice

"An important resource for health-care professionals, medical ethicists, and legal scholars who are involved in the legal rights and policy issues surrounding end-of-life decisions."—Medical Humanities Review

"Olick's book is a fine analysis of many important conceptual issues underlying advance directives....Helps refute the many naysayers about advance directives."—Norman L. Cantor, professor of law and Justice Nathan Jacobs Scholar, Rutgers Law School

"Professor Olick's admirable scholarship and public service uniquely inform and authenticate this distinguished and humane work. His exacting analysis reaffirms the central role of patient and family in medical decision making and contributes greatly to the contemporary, American quest to improve the care and treatment of the dying. This book is a signal and valuable contribution to understanding the history and evolution of the patients' rights movement."—Paul W. Armstrong, Judge of the Superior Court of New Jersey


Supplemental Materials


About the Author

Robert S. Olick is associate professor in the Center for Bioethics and Humanities, SUNY Upstate Medical University. He formerly served as executive director of the New Jersey Bioethics Commission, where he was a principal author and legislative architect of that state's advance directives law. Dr. Olick is coauthor of the book, The Stored Tissue Issue: Biomedical Research, Ethics, and Law in the Era of Genomic Medicine (2004).

248 pp., 6 x 9

Jul 2001

248 pp., 6 x 9

ISBN: 978-1-58901-029-1
Jul 2001

248 pp.

ISBN: 978-1-58901-417-6
Jul 2001

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