Autonomy's Paradox: Death, Fear, and Advance Directives

"The trouble with our times," noted Paul Valery, "is that the future is not what it used to be." As it is with' the zeitgeist, so it is with advance directives ("ADs"). ADs are declarations that one does not want particular kinds of medical treatment when one loses decision-making capacity. These mechanisms have received increased attention since the first living will statute was passed in 1976. Even more interest has arisen in light of the United States Supreme Court decision in Cruzan v. Director, Missouri Department of Health.

Since many states may now legitimately require "clear and convincing evidence" before treatment withdrawal decisions are made, ADs are perceived by many as the most effective mechanism through which that standard may be met.