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Jennifer Keller _ Jennifer Thompson


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                                                                    Annotated Bibliography
                                Annotated Bibliography

Callahan, D. (2002). Curing, caring and coping. America, 194, 12-16.

       This article addresses the economic and medical implications that will be of
       concern as our elderly population grows. Callahan points out that we will have
       increased ethical dilemmas with our elderly because we are finding ways to
       prolong their lives. Callahan addresses the President’s Council on Bioethics
       Report and to what extent it addresses our aging society. The use of Living Wills
       was high lighted as a vehicle for people to state their wishes regarding medical
       treatment; however, their flaws counter their effectiveness.

       Society needs to be more proactive and address how we are going to provide for
       our aging. We need to make Advance Directives more user friendly and secure
       ways in which they will be followed.

Cantor, M.D. (2000). Improving advance care planning: Lessons from POLST. Journal
       of the American Geriatrics Society, 48(10).

       A study revealed that advance directives are often times ignored. Possible
       explanations as to why the advance directive is often ignored include the
       ambiguity of the phrase “level of medical intervention” and the fear that the
       patient may have changed their mind about the level of care they desire.
       Suggestions to improve adherence to advance directives include standardizing
       advance directives, training for clinicians to discuss with clients the level of care
       they would like to receive in various circumstances, a system where the doctor
       can easily access the client’s documentation of their wishes, and doctors’
       confidence that the directive is an accurate reflection of the client’s wishes. The
       article concedes that as death grows closer the client often times wishes to add
       additional comfort measures to their directive.

       The points in this article are well taken. Although the idea of an advance directive
       is an excellent one, it does little good to have one if your doctor is scared to
       follow your wishes. Discussions with your doctor about the level of care you
       desire is a step that the client can take to make sure their wishes are carried out.

Capron, A.M. (1995). Abandoning a waning life. The Hastings Center Report, 25, 24-26.

       The legal battle of when it is acceptable for physicians to remove life sustaining
       support still has no victor. This article examines the case of a patient who
       experienced severe complications as the result of an injury. The family held fast
       that all medical efforts should be made. A battle ensued between the medical staff
       and the family of the patient. Specific definitions and the desire of the patient
       made this case difficult. Proper mediation was not available to properly resolve
       the case. A resolution of the doctor’s role and power in situations like this one
       need to be further examined through the legal system.
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       Doctors should be allowed to make decisions about what type of care that clients
       do and do not receive based upon their education and experience. However, they
       should be required to consult an ethics committee if their decision is not
       congruent with the family’s feelings.

Davis, L.J. (2006). Life, death, and biocultural literacy. The Chronicle of Higher

       This article focuses on trying to define identity. The question is what is the
       identity of someone who is on life support, suffering from the late stages of
       Alzheimer’s, or that of an embryo. This article asserts that the only way to make
       decisions about the ambiguous states of identity is to have biocultural literacy.
       Being aware of all the nuances that play into a particular issue is biocultural
       literacy. Those nuances include such things as scientific facts, historical contexts
       and cultural contexts. Biocultural literacy allows people to fully examine the issue
       from all perspectives and thus able to make an intelligent, informed decision. In
       doing this three things must be followed. 1. communicate facts, not opinions, 2.
       be consistent with definitions and willing to challenge inconsistent positions, and
       3. be leery of the pull of identity politics.

       The issue of what is life and where it ends and begins must be operationally
       defined. If this doesn’t happen there will always be a stand-off. However, it is
       unlikely that the left and right will ever see eye to eye on such a hot topic.

Glick, H.R., Cowart, M.E., Smith, J.D. (1995). Advance medical directives in U.S.
       hospitals and nursing homes: The implementation and impact of the patient self-
       determination act. Politics and the Life Sciences, 14, 47-59.

       This article discusses the legal requirements of the patient self-determination act
       such as letting the client know their rights to make decisions and providing
       impartial care. These requirements still offer flexibility to the client and the
       government. The article provides split predictions about the patient self-
       determination act. Those predictions include having little effect and the opposite,
       having a large impact. Findings, based upon the development of information
       about PSDAs, how clients are informed, and ways in which PSDAs influence
       advance directives. The article also discusses the need for options other than
       advance directives due to the characteristics of different groups.

       Court decisions need to be less permissive. By being less permissive, clear and
       accurate interpretations can be made.

Henry, M. Update on end-of-life issues in Utah. Utah Bar, 19(1), 6-10.

       Two cases about end-of-life have become salient in Utah. Utah’s law states that
       it’s citizens have the right to make written directives and can expect dignity and
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       privacy. Weighing personal goals with medical intervention becomes the foremost
       task. Being educated about the diagnosis and the factors associated with it is also
       important. Forms of advance directives are also discussed. The article suggests
       that current laws be modified to better fit with today. This article suggests
       education and involvement as a way to compensate for the lag in policy change.

       It is important that individuals prepare themselves for the decisions and obstacles
       they and their family members will face at the end of life. Educating themselves
       on the options available to them is an important part in making those decisions.

Hickman, S.E., Hammes, B.J., Moss, A.H., Tolle, S.W. (2005). Hope for the future:
      Achieving the original intent of advance directives. The Hastings Center Report
      Special Report. S26-S30.

       Advance directives goals have not been reached. Only 20 to 30 percent of
       American adults have an advance directive. The short comings and limitations of
       advance directives are multi-faceted and include such aspects as not
       understanding the document, the examples are too vague, vague requests for care,
       assuming that the client’s wishes have not changed, not viewed as part of the
       clinical care, failure to recognize cultural variations, lack of instruction for
       surrogates, and surrogate determination.

       Alternates to advance directives and program modifications have been made in an
       effort to address these issues. Each part of the system must work together to
       ensure that the client’s wishes are realized.

       The system must be overhauled in an effort to ensure client’s requests are met.

Kaufman, S. R., Shim, J. K. & Russ, A. J. (2004). Revisiting the biomedicalization of
      Aging: Clinical trends and ethical challenges. The Gerontologist, 44, 731-738.

       This article addresses how medicine and medical technology advancements are
       allowing us to live into advanced age. The advancements in medical procedures
       are progressive and in some cases conflicting with a person’s right to choose their
       treatment. Complicated heart and kidney surgeries are being performed on those
       persons that are in their 90’s. Ethics are raised in this article that address how we
       are to deal with the elderly whose lives we are prolonging.

       This article makes an excellent point about how will our society deal with frail
       elderly lives that we have kept alive through medical advancements. Our society
       will become inundated with the elderly population in the coming years and needs
       to be developing economic strategies on how we can afford their care. I wonder
       what price we will pay for our push for advancements in the medical field.

Mianowany, J. (2002). When advanced directives don’t say enough. Kiplinger’s
      Retirement Report, 11, 16.
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       This article was written by a young man who speaks about the ineffectiveness of
       his father’s living will. The writer explains that his father’s living will did not
       address a complicated medical condition that his father encountered and could
       have left him vulnerable to being kept alive by tubes.

       This was an excellent article that speaks of how living wills can fail us in certain
       medical situations. We must not stop by merely completing an advance directive;
       rather we must have thorough communication with our loved ones on when and
       how we want our medical care.

Marshall, P.A., (1995). The SUPPORT study who’s talking? The Hastings Center
      Report, 25.

       Modern medicine is governed by physicians. There is little discussion between
       doctors and patients in regards to the type of treatment they would prefer to
       receive. Often times, nurses acts as go betweens for the doctors and clients. In a
       study, nurses were asked to talk with patients about their end of life wishes and
       share that information with a doctor. However, this proved to be an ineffective
       way to have patient’s wishes recognized. Again, this is due to physicians’ seat of
       power within medicine.

       The way in which medicine is necessarily delivered (quick and efficient) makes it
       difficult for the patient and the physician to discuss the clients needs and wishes.
       At the same time, it is difficult for the physician to respect those wishes because
       normally their sole purpose is to save lives. Outside forces, like family members,
       may also make it difficult for the physician to follow the patient’s directions.
       Overall, Americans still find it very difficult to face their own death even though
       it has become part of mass media.

       It is essential that doctors respect the wishes of their patients despite their own
       fears and worries. How death is experienced should be at the patient’s discretion.

Murray, T.H., Jennings, B. (2005). The quest to reform end of life care: Rethinking
      assumptions setting new directions. Hastings Center Report, 35(6), S52-S57.

       The goal of this article was to revisit the issue of advance directives while
       providing lessons on how end of life should be handled. The article discusses
       numerous issues that do not support advance directives. Such issues include the
       mental stress it puts on the client, the impact the death has on the client’s family
       members, and incongruence with various cultures. Instead of focusing on
       individual needs and request they recommended that the system itself be reformed
       to fit most of the situations and most of the people. They suggest that a mid-point
       between using all interventions and none be found. They suggest that advance
       directives become more family oriented and take into consideration those left
       behind. Mediation is viewed as a way to help families make critical decisions.
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       Although much of the article was negative, it did concede that individual’s denial
       of impending death lose the power they have over their death by not taking
       appropriate actions. Having an advance directive can allow the individual to die
       on their own terms.

       The idea that the family is just as important as the individual who is dying is
       ridiculous. Although it may be tremendously difficult for family members to lose
       a loved one, it is also tremendously difficult, painful, and frightening to be poked
       and prodded only to die soon after.

Nathan, R. (2006). Straight talk about dying. Medical Economics, 83(5).

       According to this article, sometimes the best thing a doctor can do for her client is
       to talk with them about death, not provide treatment. Often times the cost of
       treatment is extremely expensive and the result is still death. This task of passing
       from one phase to the next would be made easier for everyone if more clients had
       their wishes documented. When their wishes go undocumented then the burden is
       shifted to the grieving family, who may request that all possible measures be
       taken. The writer of the article asserts that we should all have a living will to
       prevent these problems from occurring.

       Everyone should have a living will. It is irresponsible to believe that you will
       evade death. It is also irresponsible to put your family in the position to make
       such hard decisions.

Sadd, S.J. (2005). Living wills: Validity and morality. Vermont Law Review, 30(1).

       The validity and morality of living wills are examined within this article. It
       examines living wills relation to the law and its evolution; moving from essential
       suicide to a liberty in court cases. The article defines what a living will is, along
       with other basic concepts related to this topic. The advent of technology has made
       the issue of the right to die more complex than ever before and making this a
       difficult matter for both families, individuals, and the legal system. It also
       examines the flip side of the right to die coin by advocating that people be able to
       choose what type of treatment they receive.

       In line with article, it is sad to think that Americans died today because they could
       not get access to the medical care they needed and wanted. Everyone should be
       given the right to live and die in the way they see fit.

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