Interpreting advance directives: ethical considerations of the interplay between personal and cultural identity.
In many industrialized countries ethicists and lawyers favour advance directives as a tool to guarantee patient autonomy in end-of-life-decisions. However, most citizens seem reluctant to adopt the practice; the number of patients who have an advance directive is low across most countries. The article discusses the key argument for seeing such documents as an instrument of self-interpretation and life-planning, which ultimately have to be interpreted by third parties as well. Interpretation by third parties and the process of self-reflection are conceptually linked by a qualitative concept of identity. Identity is conceived here as constructed in a processual dialogue between a personal and a cultural perspective. How the cultural dimension comes into play in understanding the motivation, rejection or content of wished for end-of-life-decisions, is shown by a brief review of empirical and cultural studies. Understanding advance directives as a culturally embedded tool of self-interpretation should help to overcome urgent moral problems in clinical settings: how to interpret such documents, how to deliberate on the content and on the best form.
Department of Medical Ethics and History of Medicine, University Medical Center of Goettingen, Göttingen, Germany. silke.schicktanz@medizin.uni-goettingen.de
Silke
S
Schicktanz
D016223:Advance Directives / Q000941:ethics* / Q000208:ethnology / Q000523:psychology*; D001290:Attitude; D006801:Humans; D012649:Self Concept; D019455:Self Psychology; D012959:Socioeconomic Factors