As has been clearly shown in this section and earlier in the chapter, decisions relating to the end of life raise complex legal, political, and ethical issues. In most jurisdictions, for example, euthanasia is legal only when a person has made known his or her wishes concerning medical intervention. Even a person’s preference for hospice might not be hon­ored unless others know about it. Unfortunately, many people fail to take this step, perhaps because it is difficult to think about such situations or because they do not know the options available to them. But without clear directions, medical personnel may be unable to take a patient’s preferences into account.

There are two ways to make one’s intentions known: a living will, in which a person simply states his or her wishes about life support and other treat­ments, and durable power of attorney for health care (Figure 13.3), in which an individual appoints someone to act as his or her agent. A major purpose of both is to make one’s wishes known about the use of life-support interventions in the event that the person is unconscious or otherwise incapable of expressing them, along with other related end-of-life issues such as organ transplantation and other health care options (Rosenfeld, 2004). A durable power of attorney for health care has an additional advantage: It names an individual who has the legal authority to speak for the person if necessary. Although there is considerable support for both mechanisms, there are several problems as well. Many people fail to inform their relatives and physicians about their health care decisions. Others do not tell the person named in a durable power of attorney where the document

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