Entire Transcript in Adobe Acrobat Format - National Reference ...

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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.