Advance Directives and Surrogate Decision Making in Health Care United States, Germany, and Japan

"The objective of this transnational, transdisciplinary study was not to predict the future. Much less was it to determine which culture has the best legal, public policy, and ethical systems. Rather, it was to understand the systems--their similarities and differences--and their implications for shaping the public policies that will shape the legal and medical world to come."--from the introduction Advance directives to determine the care of terminally ill patients have revolutionized health care decision making. But writing a directive that accomplishes exactly what a patient wants can be a difficult process and can be ethically controversial. While Americans, deeply immersed in Western liberal political philosophy, have an intuitive attraction to advance directives, other cultures do not. In this volume, an international team of experts examines the controversy surrounding advance directives in three countries: the United States, Germany, and Japan. Within each section, the subjects are addressed from the points of view of clinicians, legal experts, and bioethicists. The authors find that the United States and Japan are at opposite ends of a spectrum of opinion regarding patient autonomy, whereas Germany falls somewhere between.