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After Cruzan: the "values base" to advance directives.

P K Keyser

    Orthopedic Nursing
    |September 1, 1992
    PubMed
    Summary

    Technological advances create ethical dilemmas in healthcare, impacting life-sustaining treatment decisions. A Value History Form aids in documenting patient wishes for advance directives, ensuring clear evidence of their values.

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    Area of Science:

    • Bioethics
    • Medical Law
    • Health Policy

    Background:

    • Technological advancements in healthcare present complex ethical challenges for professionals and patients.
    • Difficult treatment decisions are frequently required, particularly concerning life-sustaining care.
    • The 1990 Supreme Court ruling in the Nancy Cruzan case highlighted issues surrounding patient autonomy and end-of-life care.

    Purpose of the Study:

    • To examine the ethical considerations surrounding advance directives in light of recent legal precedents.
    • To explore the potential need for enhanced evidence of patient wishes regarding life-sustaining treatment.
    • To introduce a tool that facilitates the expression of patient values and beliefs in healthcare decision-making.

    Main Methods:

    • Review of legal precedents, specifically the Nancy Cruzan case.
    • Analysis of the role and limitations of current advance directives (living will, durable power of attorney).
    • Introduction and conceptualization of a Value History Form as a supplementary tool.

    Main Results:

    • The Cruzan ruling may necessitate a higher standard of evidence for patient treatment preferences.
    • Existing advance directives might not fully capture the nuances of patient values.
    • The Value History Form offers a structured method for patients to articulate their beliefs.

    Conclusions:

    • There may be a need for "clear and convincing" evidence beyond traditional advance directives.
    • Patient values and beliefs are crucial components of ethical healthcare decision-making.
    • The Value History Form can serve as a valuable instrument in ensuring patient-centered care and respecting autonomy.
    Keywords:
    Death and Euthanasia

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