Bioethics Blogs

More Safeguards Often Mean Less Access

More safeguards often means less access.  This is a common theme in end-of-life laws and policies.  Here are just two examples.

North Carolina requires individuals to sign an advance directive in the presence of both two witnesses and a notary public. In contrast, most states require only one or the other to make an advance directive legally binding. Even assuming that the NC requirement helps assure the soundness of the advance directives, it makes it much harder for individuals to complete advance directives.  This week, the North Carolina House failed to pass H.B. 146, which would have amended the statute.   

The same debate occurs with respect to POLST.  There are various execution requirements, many of which might help assure that the orders on a POLST reflect the patient’s values and preferences.  But many extra safeguards also have the effect of making it harder to complete a POLST.  For example, many states permit POLST to be signed by an MD, NP, or PA. Others limit to just MD. That surely limits access to POLST to those in rural areas and LTC settings.

Like medical interventions, legal interventions introduce both benefits and harms. To determine whether mandating a safeguard is prudent, it must be weighed and balanced against the harms it causes.  

Sure, we could demand perfection in advance planning instruments. But then hardly anyone will have or use them.  

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.