title: Advance directives outside the USA: are they the best solution everywhere?
abstract: This article evaluates the potential role of advance directives outside of their original North American context. In order to do this, the article first analyses the historical process which has promoted advance directives in recent years. Next, it brings to light certain presuppositions which have given them force: atomistic individualism, contractualism, consumerism and entrepreneurialism, pluralism, proceduralism, and "American moralism." The article next studies certain European cultural peculiarities which could affect advance directives: the importance of virtue versus rights, stoicism versus consumerist utilitarianism, rationalism verus empiricism, statism versus citizens' initiative, and justice versus autonomy. The article concludes by recognising that autonomy has a transcultural value, although it must be balanced with other principles. Advance Directives can have a function in certain cases. But it does not seem adequate to delegate to advance directives more and more medical decisions, and to make them more binding everyday. It is indispensable to develop other decision-making criteria.
authors.affiliation: Department of History of Medicine, School of Medicine, Complutense University of Madrid, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Sanchez-Gonzalez
mesh_terms: D016223:Advance Directives / Q000266:history / Q000331:legislation & jurisprudence; D026686:Beneficence; D032982:Contracts; D018864:Cultural Diversity; D028781:Ethical Relativism; D004992:Ethics, Medical; D005060:Europe; D049672:History, 19th Century; D049673:History, 20th Century; D007258:Informed Consent / Q000266:history; D038622:Internationality; D009014:Morals; D028701:Patient Rights; D026684:Personal Autonomy; D028723:Personhood; D010684:Philosophy / Q000266:history; D011057:Politics; D040841:Resource Allocation; D018570:Risk Assessment; D035621:Secularism; D012941:Social Responsibility; D012945:Social Values; D035502:Trust; D014481:United States; D028722:Virtues; D028761:Withholding Treatment