Field of medicine: Ethics.

Format: Softcover book.

Audience: As are all of the books in this series on clinical medical ethics, this text is intended for clinicians and laypersons who wish to write advance directives, members of ethics committees, bioethicists, and hospital policymakers.

Purpose: It is often difficult to make sense of advance directives, and the author documents the reasons why. These reasons include concerns about patient competency, patient and surrogate understanding of the medical situation, and the practical aspects of developing and applying advance directives. The author argues that advance directives are not so much legal documents as expressions of patients' values. Thus, they do not close a discussion with caregivers but rather contribute to it and allow for the participation of proxies.

Content: This new edition was occasioned by rapid legal developments, new court cases, and critical thinking about the problems of family or surrogate decision making, patient autonomy, and medical futility. Clarifications of advance directives are accompanied by case examples. The cases underline the author's central point that advance directives must contribute to a discussion that is embodied in shared decision making.

Highlights: An updated bibliography is accompanied by a listing of all federal and state statutes from the New York-based group Choice for Dying. Also included is a current list of court cases relevant to questions about patient decision making, advance directives, and medical futility.

Limitations: This edition does not discuss the differences in laws from state to state, nor does it offer a good comparison of various legislative efforts. The author assumes that informed physicians and patients will know the laws in their own states.

Context: This is the best single book in the field of advance directives.

Reviewer: David Thomasma, PhD, Loyola University Medical Center, Maywood, Illinois.

Commentary: Advance directives are both personal and communal. Acknowledging this eliminates both over-reliance on legalities and the use of directives as trump cards in a game of power that is often conducted at the bedside of gravely ill, incompetent patients.