Your Last Year:

Introduction                                       5

A.    THE PURPOSE OF AN ADVANCE DIRECTIVE FOR MEDICAL CARE        5

    1. Not Everyone Needs a 'Living Will'.            6
    2. But if You Might Disagree with Standard Medical Care,
        You Do Need a 'Living Will'.            7
    3. Going Beyond Generic Medical Ethics.            10
    4. Your 'Living Will' Should Not Apply in Emergencies.        12
    5. A Clear Advance Directive
        Will Keep Your Death Simple and Private.            13

B.    PROBLEMS OF GENERIC 'LIVING WILLS'             15

C.    THOUGHTLESS, IRRATIONAL, & MISINFORMED 'LIVING WILLS'        17

D.    YOUR MEDICAL ETHICS             21

E.    GETTING DOCTORS TO COMPLY WITH YOUR ADVANCE DIRECTIVE     27

F.     PUT YOURSELF INTO YOUR ADVANCE DIRECTIVE        32

G.    LAWMAKERS MAKE RIGHT-TO-DIE LEGISLATION            36

H.    ADVANCE DIRECTIVE WORKSHOPS & OTHER DISCUSSIONS           37

I.      FOLLOW THE FORMS PROVIDED BY YOUR STATE                            38

PART I.  Scope of Your Declaration
           & Appointing Proxy Decision-Makers            39

Question 1:  Should Your Advance Directive for Medical Care apply      
    only when you are terminally ill or permanently unconscious
    or should it apply to all situations in which you are not capable
    of making medical decisions or are unable to express your wishes?    39
           
Question 2:  What person or persons should make medical decisions
    for you if you become incapable of making your own decisions
    or unable to express your wishes?             44

    A.    Family Members as Proxies.            44
    B.    Some Family Members Might Be Too Close Emotionally.        47
    C.    Two Kinds of Proxies:
            For Routine Decisions and Life-Ending Decisions.        49
    D.    Medical Care Decisions Committees (MCDCs).        51
    E.    Proxies for Gays and Lesbians
            and other Unconventional 'Families'.            56
    F.     Avoid Selecting Professionals as Proxies.            58
    G.    What Will Happen If I Have No Proxy?            60
    H.    Self-Appointed Medical Care Decisions Committees.        61

Question 3:  When and how should your proxies be empowered   
    to make medical decisions?                63

    A.    Determining Your Capabilities.            65

        1. Background for Legal Incompetence.            66
        2. Power of Doctors to Declare Incompetence.        67
        3. Some Tests of Capability to Make Medical Decisions.        68

    B.  Voluntary Empowerment of Your Proxies.            70
    C.   Continuing Cooperation between You and Your Proxies.        73
    D.   Maintaining Your Settled Values if You 'Change Your Mind'.       76
    E.   Changing Your Proxies.            77
    F.    When Your Proxies Might Go Beyond Your Advance Directive.    78

PART II.  Quality-of-Life Issues                    81

Question 4:  What level of personhood
    do you wish to preserve thru medical care?
    When—according to your own criteria—
    would you become a former person?            81

    A.    Questions for Proxies
            about Consciousness and Self-Consciousness.        82
    B.    Questions for Proxies about Memory.            84
    C.    Questions for Proxies about Language and Communication.        85
    D.    Questions for Proxies about Autonomy.            88

Question 5:  Where do you draw the line between a quality of life
    worth preserving and the remnants of biological life
    that should be mercifully shut down?            94

Question 6:  How do you want to be treated
    if you get Alzheimer's disease
    or some other condition that limits your mental abilities?        97

PART III.  Pain Control, Nursing Home,
             Financial Limits, & Medical Information         103

Question 7:  If you are in serious pain, what do you want done?           103

Question 8:  Do you want to be put into a nursing home?  If so,
    for how long, under what conditions, and for what purposes?        106

Question 9:  Where would you prefer to die?                 112

Question 10:  Will you put financial limits on your terminal care?        113

Question 11:  How much do you want to know
    about your medical condition and prognosis?            115

PART IV.  Life-Ending Decisions            118

Question 12:  When should all curative treatments be ended?        118

Question 13:  When should Do-Not-Resuscitate orders
    be written for you?               122

    A.    Avoid Blanket Do-Not-Resuscitate Orders.            124

    B.    Situations in which You Want to Be Resuscitated.        126

        1. Drug Overdose.            126
        2. Electric Shock.            126
        3. Drowning.            126
        4. Blood Loss.            127
        5. Diabetic Shock.            128

    C.    Situations in which You Do Not Want to Be Resuscitated.        129

        1. You Are Expected to Die.            129
        2. You Cannot Tolerate Another Resuscitation.        129
        3. Resuscitation Would be Medically Futile.            129
        4. You Have a Very Low Quality of Life.            130
        5. You Are Ready for Death to Come.            131
        6. You Are Already in an Irreversible Coma.            131
        7. The Resuscitation is Dictated by Institutional Policy
        Rather than Personal Need.            132
   
    D. Some Special Situations for Resuscitation Decisions.        133

    1. "Slow Code"—Sham Resuscitation.            133
    2. DNR as the Only Advance Directive.            134
    3. DNR in the Operating Room.            134
    4. DNR in New York State —and other legislative efforts.        135
    5. DNR at Home.            137
    6. Automatic DNR When Entering a Nursing Home or Hospice.    137

Question 14:  How long should you be maintained by life-supports?    138
               
Question 15:  Should food and water ever be withdrawn or withheld
    in order to shorten the process of your dying?            142

Question 16:  Do you endorse more active means of ending your life?
    Do you believe you have a right to die?
    Voluntary death? Merciful Death?            144

Question 17:  Under what conditions would you request death?          146

Question 18:  Do you wish to join the One-Month-Less Club?        150

Question 19:  Which definition of death should apply to you?        152

    A.    Brain-Death.                153
    B.    Coma or Permanent Unconsciousness.            154
    C.    Persistent Vegetative State.            155

PART V.  Disposition of Your Remains            158

Question 20:  Do you wish to donate your organs
    to other persons who need them?            158

    A.    Ways of Increasing Organ-Donation.            160
        1. Reasons for Not Donating Organs.            160
        2. Changes in Law to Increase Organ-Donation.        163
        3. Financial Incentives to Increase Organ-Donation.        166

    B.     Coordinating Life-Ending Decisions with Organ-Donation.        171
   
Question 21:  Will you donate your body
    for use in medical science or education?            174

Question 22:  What other plans have you made for your remains?        175

PART VI.  Philosophical-Religious Beliefs
              & Readiness for Death            175
   
Question 23:  What philosophical, ethical, or religious beliefs
    do you hold that are relevant
    to your medical care and other end-of-life decisions?        175

Question 24:  Are you ready to die now?  If yes, explain. 
    If no, what preparations (practical, interpersonal, spiritual)
    would make you more ready to die?
    What projects do you wish to complete before you die?        181

PART VII. State Forms, Supportive Statements, & Appendices    182

A.    INTEGRATING YOUR 'LIVING WILL' INTO STANDARD FORMATS        182

B.    GETTING COOPERATION FROM YOUR DOCTORS            184

C.    GETTING COOPERATION FROM YOUR HOSPITAL            187

D.    GETTING STATEMENTS OF COOPERATION FROM YOUR PROXIES        188

E.     DOCUMENTING THE PROCESS OF CREATING YOUR 'LIVING WILL'        189

F.     REVIEWING AND REVISING YOUR 'LIVING WILL' PERIODICALLY        190

G.    DISTRIBUTING COPIES OF YOUR ADVANCE DIRECTIVE        191

James Park’s Advance Directive for Medical Care            195