Other than taxes, the only other certainty in life is death. People don’t like to pay taxes or think about dying. But on April 16th, National Healthcare Decisions Day (NHDD) serves to remind people to complete their advance directives. Like a passport, an advance directive permits an individual to proceed from one world to another with an easy stamp of approval. Without the proper paperwork, patients at the end of life are often detained and experience a loss of dignity. Instead of being a natural process, dying has evolved into a medicolegal nightmare with only a DIY option for ethical end-of-life care. 

If a 93-year-old woman in a diaper presents to the emergency department in extremis, is it more respectful to shove a breathing tube into her lungs or provide her comfort care? Does she have an advance directive, and what does it state? What does her family advocate? Should this be anyone’s guess or can medical personnel follow a standard emergency protocol? This woman’s medical condition is life-threatening and prognosis is futile. It’s unlikely that she wishes for aggressive treatment given her limited quality of life. Might the treating physician do unto her as he would prefer others do unto him without questioning if she has an advance directive?

Who ultimately ensure the dignity of this woman and decides the moral course of action?