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225 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 and so on, all right. Or if they say it is not that we do not value it but that it conflicts with some other value that we have that precludes us doing it. Now, again, I say that I do not have any background in this area and maybe this is not relevant but just listening to the discussion -- DR. CHILDRESS: Let me add one point before getting to Eric and Bernie. When we ask the question would it work here, has it worked in another area, I think we do have to ask work in relation to what. The critical question here, and I think we saw it in the exchange between Zeke and Alex is work in terms of facilitating research, work in terms of protecting subjects and their autonomy. I am not putting those in cast but work -- it was differently -- there was a different emphasis in your comments as to whether it would work or not I think and it seems to me that the fundamental attention that we have to face in this area because it can -- it can certainly be said it works if only one percent fill out a form it works in one sense but it will not permit research to go forward. So a lot depends on what you are emphasizing, I think, in terms of what works.
226 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 DR. EMANUEL: Wait a second. (Simultaneous discussion.) DR. EMANUEL: I am a little uncomfortable here by people saying that if we have the form filled out that is the only way in which we have protection of -- (Simultaneous discussion.) DR. CASSELL: No, it falls on the straw man. MS. BACKLAR: It has nothing to do with just filling it out. DR. EMANUEL: As an integral, essential, inescapable part. DR. CHILDRESS: It is a sorting device. DR. EMANUEL: No. I am hearing if you do not have this consent you are out. You are not protected. We have no assurance of protection and you are out. DR. CHILDRESS: No, we did not say that. Alex, explain it. MR. CAPRON: Well, if you do not have this -- if you -- put it this way: We would have many more advance directives for end of life care if the public and physicians knew that every medical technology had to be used on every patient who did not fill out an advance directive, which I would regard -- most of the care that would be provided beyond a certain point would not be
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NATIONAL BIOETHICS ADVISORY COMMISS
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