HEALTH CARE, AGING, AND END OF LIFE: USING COMMUNITY BIOETHICS DIALOGUES TO PROMOTE INDIVIDUALIZED PERSONAL DECISIONS AND ADVANCE CARE PLANNING

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In 1976, the New Jersey Supreme Court ruled that Joseph and Julia Quinlan could authorize removal of life support from their comatose daughter. Since that critical ruling, every state has passed legislation allowing individuals to articulate personal treatment preferences in anticipation of life’s end. However, only a small percentage of people complete formal documentation or discuss their treatment preferences with family members or health-care providers. As a result, family members may be asked to make decisions under pressure without understanding the medical issues or the implications for the person. Numerous efforts focus on encouraging health-care professionals’ understanding of their patients’ treatment preferences but do not address the need for public awareness of medicine’s limits and the effect on end-of-life choices. Community bioethics dialogues provide a means for sharing information regarding the importance of considering health-care ethics issues and articulating end-of-life concerns. My thesis is that personhood is central to all conscious individuals and is a critical consideration in making treatment choices. Advance Care Planning is an important component for these plans, but is not the sole task in making personalized health-care decisions. An understanding of the complexities of the health-care system is needed to provide a framework for assessing treatment options and making decisions. Community Bioethics Dialogues provide a viable platform for educating individuals on the health-care system and the importance of making individualized treatment choices. During the past three years, Community Bioethics Dialogues held in Galveston, Texas, provide a model for applying this example of deliberative democracy, demonstrating the initial efficacy of the platform. With education, I believe that some of the current problems associated with end-of-life treatment options can result in better care across the health spectrum, lower costs, and reduced suffering, and I offer a template for expanding dialogues to other groups.

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End-of-life planning, Community Bioethics Dialogue, deliberative democracy, personhood, consciousness, Advance Care Planning, decision making
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