The Values History: An Innovation in Surrogate Medical Decision-Making

Abstract

In the United States we prize our freedom as individuals to make our own decisions, however unwise they might seem to others. This devotion to the principle of autonomy (from the Greek “autos” meaning self and “nomos” meaning rule) is obvious in our legal system as well as in a variety of social rules and customs that govern our daily lives.Difficulties arise, however, when we lose, either temporarily or permanently, the capacity to make our own decisions. Ideally we would have planned ahead for possible incapacity in order to retain control over the future course of our lives. Unfortunately the ideal situation rarely exists. Most of us avoid anticipating the possibility of our own incapacity, and by implication, loss of control. Until recently attention has not been paid to developing and supplying accessible and understandable information about advance directives that could assist us in such planning. And most of us still prefer (or at least resort to) informal, often uninformed, family decision-making arrangements.

The HIV-specific advance directive

“…Current advance directive documents-for example, the Medical Directive, 3 Let Me Decide directive, 4 University of Toronto Centre for Bioethics Living Will, 5 Values History, 6,7 or the forms prepared by lawyers and governments-are all generic. Intended for the general public, generic advance directives can be criticized because they contain hypothetical, often irrelevant choices and inadequate prognostic information.…”

Biobanking: shifting the analogy from consent to surrogacy

“…In clinical medicine, the response has been twofold: to emphasize the importance of understanding basic patient values rather than speculating on future circumstances long in advance, and to conceive of the advance directive/surrogacy process as an evolving conversation over time in response to changing medical circumstances. 10,11 This transformation has been helpfully summarized as a movement from a legal-transactional to a communications model. 12 A parallel transformation must occur in the ethics of biobanking.…”

Patient incompetence and substitute decision-making: an analysis of the role of the health care professional in Dutch law

“…If that is the case, this aspect of the relationship deserves more attention both in the legal and ethical debate, and in professional education [71]. A practical instrument that may be helpful here is the so-called values history [72][73][74]. This is a form with several areas of interest, subdivided into specific questions.…”