Question: It is incredibly difficult for a person to know ahead of time what measures they might want taken in the case that they are unable to communicate their wishes for what actions to be taken. There are so many situations that would need to be taken into consideration. It is even more difficult to make that decision for a loved one that you want to survive but you also do not want them to live in a way they would not want to.

As a healthcare administrator, I feel that securing advance directives at the time of inpatient registration or emergency care may not be the best time to get that information. In those instances, people are not completely focused on what their actual wants are and are possibly under a lot of stress. I feel that in that moment many people are scared and this is not a decision that should be taken lightly. I feel that people need time to think about these decisions and decide what they would really want.

In both the Quinlan and Shiavo cases an advance directive would have been really good things to have. This would take the decision off of the family and if they wish was to terminate life at that point, it may not have put them through the turmoil and pain of court hearings and watching their loved ones being kept alive in such a capacity. The wants and wishes of both of them would have been facilitated. The problem that may have come about is the advance directive may not have given the family time to come to terms with it and decide that it is what the patient wanted. So this could have also caused much turmoil and pain if the family decided to fight it. But in both cases, the patients were not able to fill them out upon arrival. They were also both very young and this tends to not be something that someone that age thinks about seriously.

I believe the reasons why patients don't create such documents include some of the following:

• being young and healthy and believing that nothing will happen to them

• fear of making the wrong decision

• avoidance due to not having all of the facts of what the situation may be

I feel that the immediate family should be involved in the decisions, unless there is reason to believe they do not have the patients best interests at heart. I do feel that therapy for those involved should be included as well as the use of the ethics committee. Once all evidence is looked at, and it is decided it is in the patients best interest, then proceed. Self determination is very important. I feel that if there is a point that the patient has expressed his/her wants that it should be recognized and taken into consideration.