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Death & Dying

Review of "Planning for Uncertainty"

By David John Doukas and William Reichel
Johns Hopkins University Press, 2007
Review by Kevin M. Purday on Jun 24th 2008
Planning for Uncertainty

This is an extremely specialized book. The authors, who are both medical doctors and academics concerned with medical ethics, have produced a book which explains the consequences of the Patient Self-Determination Act that Congress passed in 1990. The implications of the act include numerous aspect of medical ethics and it is these that make the book of particular help and interest.

The first area to be elucidated is that of advance directives. The authors carefully explain what they are and under what circumstances they would be particularly useful. The cases of Nancy Cruzan, Terri Schiavo and, to a lesser extent, Karen Quinlan are employed to illustrate the difficulties that may occur when even quite young people meet with some unforeseen and tragic accident. Living wills, a variant of advance directives, are fully explained. The appointment of a proxy and the importance of the choice of proxy are gone into in great detail. That leads to the whole area of power of attorney and the legal knowledge of the authors becomes very important here as they explain the importance of a durable power of attorney. This in turn leads to a discussion of the Values History as a means of elucidating an advance directive/living will.

The authors make each of the legal points extremely clearly but what is particularly interesting from a psychological point of view is the wide discussion of medical ethics in relation to artificial feeding and life support systems, etc. The authors take great pains to explain all the ins and outs and give the reader a vivid picture of what could happen after, for example, a car accident, of what procedures are available to doctors, of what positions members of our family may adopt, and of the ways that our directives when clearly expressed in legal form guide the doctors. There is a huge amount of extremely clear-sighted advice contained in this book.

The authors make it plain that each state has slightly different rules. This is where the website links to advance directive forms state by state in the appendix are particularly useful. The book contains other useful website links, a blank example of an advance directive, guidance for writing a values history, and an example of an advance directive in brief (ADB) card which can be carried around in one’s wallet or handbag.

This is a book with a very narrow and precise focus. However, the authors make the very good point that all of us ought to think about this issue because we never know when misfortune may overtake us. For those people wise enough to give thought to and act upon their advice, this book is invaluable.


© 2008 Kevin M. Purday

Kevin M. Purday has just completed his fortieth year as a teacher and has recently returned to the U.K. after being principal of schools in the Middle East and Far East. His great interests are philosophy and psychology.

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