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199 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 So it is -- I mean, I think as we heard from the people in the New York group the idea that people are actually going to do this is, I think, clearly unrealistic. You just have to understand that if you put this into place you cannot have any greater hope than five or ten percent of people are ever going to do this. I think we must be very clear about that. It is not because only five or ten percent of people may want to participate in research. I mean, if there is anything we know, there is a big gap between attitude and action here. DR. CHILDRESS: I have Eric and then Alex. DR. CASSELL: And then the other issue of it is then they are not heeded. The evidence shows that then the people for whom they were written, that is the physicians in care, do not pay attention to them. Now the conclusion that is usually drawn is that is because they are bad guys and they do not want to pay attention. I think that is not it at all. They do not know how. They do not know how not to treat. They do not know how in this kind of thing to apply a directive written way ahead to a piece of research which will not really precisely the way it was that that directive was written for so we have this problem.
200 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 There is another aspect of this which is we keep talking about more communitarian view of what the process is and then when we come to write a recommendation we are right back to trying to do it as though there was no community whatsoever and we have not protected this person totally against without having put some kind of standard in that would allow the research to go on and protect the individual. Now, I do not know -- you could come back to me and say, "Well, Eric, can you solve that?" Well, I do not know whether I can but I know that is -- even if I cannot it is not a reason to keep putting back into place something that did not work before. DR. CHILDRESS: One criticism of the draft notes that we make the family a part of the health care team, that is care giving a part, but we then take the family away from this individual. But let me just, before turning to Alex, raise one question for Zeke. Your comments were stated in general terms. Do you take them to apply to what one might call procedural events, directives, as well as substantive ones, that is to ones that recommend a designated decision maker versus the advanced directives that set out standards for decision
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- Page 165 and 166: 162 1 2 3 4 5 6 We will adjourn now
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There is another aspect of this which is we<br />
keep talk<strong>in</strong>g about more communitarian view of what the<br />
process is and then when we come to write a recommendation<br />
we are right back to try<strong>in</strong>g to do it as though there was no<br />
community whatsoever and we have not protected this person<br />
totally aga<strong>in</strong>st without hav<strong>in</strong>g put some k<strong>in</strong>d of standard <strong>in</strong><br />
that would allow the research to go on and protect the<br />
<strong>in</strong>dividual.<br />
Now, I do not know -- you could come back to me<br />
and say, "Well, Eric, can you solve that?" Well, I do not<br />
know whether I can but I know that is -- even if I cannot<br />
it is not a reason to keep putt<strong>in</strong>g back <strong>in</strong>to place<br />
someth<strong>in</strong>g that did not work before.<br />
DR. CHILDRESS: One criticism of the draft<br />
notes that we make the family a part of the health care<br />
team, that is care giv<strong>in</strong>g a part, but we then take the<br />
family away from this <strong>in</strong>dividual.<br />
But let me just, before turn<strong>in</strong>g to Alex, raise<br />
one question for Zeke.<br />
Your comments were stated <strong>in</strong> general terms. Do<br />
you take them to apply to what one might call procedural<br />
events, directives, as well as substantive ones, that is to<br />
ones that recommend a designated decision maker versus the<br />
advanced directives that set out standards for decision