Advance directives are statements made while a person is competent and able to epress their wishes, and are about what they would like done to them and what they would not like done to them in terms of receiving healthcare, to become operative in the event of their becoming incompetent and unable to express their wishes.

Are they useful extensions of genuine patient autonomy which Christians should spport or are they a backdoor to euthanasia? Are they helpful guides for health professionals or do they force doctors and nurses to practise with one hand tied behind their backs? Do they already have the force of law? Should they have the further force of statute law?

Because of questions like these, the whole subject of advance directives has been one of the subplots in the euthanasia debate of the 1990s. This little booklet provides a lot of help in understanding the strands of this subplot and is recommended. It draws a distinction between 'medical treatment' and 'ordinary care'. The first can be refused; and of the second - 'ordinary care is almost always owed to patients: to deny it when it could be provided is contrary to the basic respect due to any human life'.

After a good review of such general issues, specific issues which might affect Catholic hospitals and nursing homes, and Catholic doctors and nurses are discussed. These will be of interest to members of other Christian traditions.

Bound in at the end of the booklet is a 'Christian Advance Declaration for the management of serious illness'. After the hitherto lukewarm recognition of advance directives, this may at first appear paradoxical, but the authors acknowledge this in the advice given in this Appendix, where after a further warning they state: 'If, however, you feel that you ought to sign such a document (or if it should come to be expected of you) we strongly advise that you discuss the matter first with your doctor and with your priest, or for a non-Catholic, your minister'. The Declaration then sums up sensibly and clearly the approach taken in the booklet, with strong support for the practice of ordinary care.

All in all, a worthwhile read. The highlight for me was a soundbite to counter those who would use Advance Directives with inappropriate legal force in order to try to bring in euthanasia by the back door. Some wordings do not constitute 'a refusal of treatment' but 'a refusal of life'. There's a big difference!

Andrew Fergusson
(Editor)