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197 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 We are now going to import something which does not work somewhere else into this area and I am concerned about that. I think the intention is understandable and right but the potential operation is likely not -- for lots of reasons not to meet that. So I am not -- I think this is a very important step that, you know, needs elaboration and consideration. I am very unclear as to why it is there. DR. CHILDRESS: Thanks. We will get response from others. I share many of those reservations, as Tom mentioned, regarding the report this morning. This is a work in progress and the fact that it appears in this form does not suggest or should not be taken to suggest unanimity among the subcommittee members about particular matters here. So this is one that is still under discussion. Eric? DR. CASSELL: I just want to register I share the same concerns. DR. FLYNN: Could we hear -- DR. CHILDRESS: Laurie? DR. FLYNN: I do not mean to interrupt. I just
198 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 would benefit from hearing a little bit more discussion from Zeke or Eric as to the concerns they have seen in other areas and the dangers they see in trying to import this into this arena. DR. EMANUEL: Well, I mean the sort of end of life area where the advanced directives have had the most run for the money. There are a number of problems which have been identified. Failure to fill them out. Failure to understand what you have filled out. Failure to implement them at the appropriate time. Questions about stability over time. And I think relying -- and they have never been tested in the area of research. They have been -- I mean, we have looked at them in an area that has a lot more salience maybe for people. I think as a mechanism we have had, you know, maybe 20 years of experience with them and I generally think the conclusion in the field even by myself, who is an ardent advocate, is we trusted them too much. At best they are part of a process. And we end up, like many things, relying on a document that does not seem to reflect the process. Most people do not use them even after extensive publicity. I mean, it is hard to understand how much publicity. You know, most people do not do it even if they want them.
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NATIONAL BIOETHICS ADVISORY COMMISS
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I N D E X Welcome 1 Report from the
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