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BackgroundAdvance directives imply the promise of determining future medical treatment in case of decisional incapacity. However, clinical practice increasingly indicates that standardized ADs often fail to support patients’ autonomy. To date, little data are available about the quality and impact of ADs on end-of-life decisions for incapacitated acute stroke patients.MethodsWe analyzed the ADs of patients with fatal stroke, focusing on: their availability and type, stated circumstances to which the AD should apply, and stated wishes regarding specific treatment options.ResultsBetween 2011 and (...) 2014, 143 patients died during their hospitalization on our stroke unit. Forty-two of them had a completed and signed, written AD, as reported by their family, but only 35 ADs were available. The circumstances in which the AD should apply were stated by 21/35 as a “terminal condition that will cause death within a relatively short time” or an ongoing “dying process.” A retrospective review found only 16 of 35 ADs described circumstances that, according to the medical file, could have been considered applicable by the treating physicians. A majority of patients objected to cardiopulmonary resuscitation, mechanical ventilation, and artificial nutrition, while almost all directed that treatment for alleviation of pain or discomfort should be provided at all times even if it could hasten death.ConclusionsThe prevalence of ADs among patients who die from acute stroke is still low. A major flaw of the ADs in our cohort was their attempt to determine single medical procedures without focusing on a precise description of applicable scenarios. Therefore, less than half of the ADs were considered applicable for severe acute stroke. These findings stress the need to foster educational programs for the general public about advance care planning to facilitate the processing of timely, comprehensive, and individualized end-of-life decision-making. (shrink)

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The trouble with situation ethics from an author’s point of view is that the whole thing can be summed up in a few sentences. This means that it is difficult to write a book about it—and doubly difficult to write a second book about it. Joseph Fletcher has solved this problem by publishing as his second book a series of articles about half of which were published prior to his first book while the others merely repeat what he has said (...) already. This second book gives us new examples of situation ethics but little new thinking on the subject. Chapter IX on Euthanasia is typical: it is written at the level of a popular magazine. Having given a stock outline of the problem Fletcher proposes his ‘solution’—creative and courageous facing up to the issues! Chapter X on Business is perhaps the best. Here Fletcher shows himself aware of some of the objections which can be made against his position—objections based on a consideration of long-term consequences of certain types of acts. He also shows awareness of why his opponents consider certain actions to be evil always. Fletcher’s reply puts him nearer to the existentialist type of situation ethics than would appear from the rest of his writings: he stresses ‘the ambivalences and ambiguities that go along with freedom’ and the inability of anybody to assess objectively all of the motives, means and ends at stake. In this book, as in his other one, Fletcher is guilty of exasperating over-simplifications and non sequiturs For instance he maintains that love and justice are identical. To show this he spends three-and-a-half pages examining the meaning of the word ‘love’ and devotes three-and-a-half lines to justice. But perhaps it ought to be admitted that one reason for exasperation is that it is difficult to find a defensible alternative to Fletcher’s approach. The manuals certainly do not provide an answer. They, like Fletcher, fail to distinguish between abstract universality and concrete generality. Any attempt to base universal laws on an abstract ‘common denominator’ will result in legalism or leave the laws as mere guide-lines. A re-examination of what is meant by a universal principle is an urgent necessity. This book will have served a useful purpose if it brings this home to us. (shrink)

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This book is excellent value for money. It contains excerpts from twenty-four writers with brief but helpful introductions and notes by Professor Smart. By making the book so long Professor Smart has been able to include fair-sized selections from so wide a range of authors that the teacher who wishes to use it as a text-book has a considerable degree of choice. Of course no selection will please everybody. Perhaps it will seem like carping criticism to say that it is (...) difficult to justify the omission of Nietzsche. Better perhaps to be grateful that the selection strikes a fair balance between Continental and Anglo-Saxon writings. The book will be a boon to any lecturer who is prepared to admit publicly that he cannot reasonably expect students to study all the sources in the original. (shrink)

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Klaus Michael Meyer-Abich: Was es bedeutet, gesund zu sein. Philosophie der Medizin Content Type Journal Article Category Book Review Pages 57-59 DOI 10.1007/s10202-011-0096-8 Authors Dorothee Dörr, Europäische Akademie GmbH, Bad Neuenahr-Ahrweiler, Germany Journal Poiesis & Praxis: International Journal of Technology Assessment and Ethics of Science Online ISSN 1615-6617 Print ISSN 1615-6609 Journal Volume Volume 8 Journal Issue Volume 8, Number 1.

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