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By Gere B. Fulton

Find out how economics, advertising and marketing, and administration impact ones outlook on dying and demise.

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Ours is a society that prizes the sovereignty of the individual. Respect for the autonomy of the patient is an important precept of medicine. While it is clear that competent patients have a right to direct the kind and amount of medical treatment that they will receive, many of us are concerned about what might happen to us when we no longer have the ability to decide for ourselves. Chapter 4 is about just that. Advance directives have been promoted as the only real way of guaranteeing that one's wishes concerning life-sustaining medical treatment will be respected when competence is lost.

One of these is our belief in the importance of understanding how change-change in how we live and change in how we die-has influenced our attitudes about death and dying. Another is our belief that knowledge can be an important factor-perhaps the most important-in helping us understand and cope with the many crises and controversies surrounding the topic of death and dying. Our goal throughout the book has been to make death less a stranger and thereby help dispel some of the irrational fears that seem to haunt so many of us.

While it is clear that competent patients have a right to direct the kind and amount of medical treatment that they will receive, many of us are concerned about what might happen to us when we no longer have the ability to decide for ourselves. Chapter 4 is about just that. Advance directives have been promoted as the only real way of guaranteeing that one's wishes concerning life-sustaining medical treatment will be respected when competence is lost. In this chapter, we describe the evolution of living wills and durable powers of attorney for health care as instruments of self-determination.

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