Advance directives : whose will be done? : ethics article

A very good friend of mine underwent an aortic valve replacement and a mitral valve repair in September last year, at the age of 84 years. He had been very reluctant to have the surgery, but his increasing shortness of breath caused significantly impaired quality of life and greatly impacted his activities of daily living. He had also received very positive reports regarding the outcome of the operation from various acquaintances, most of them aged between 75 and 80 years at the time of their surgery. He had expressed reservations about having the operation to the cardiologist and the cardiothoracic surgeon, as he had partial bowel and bladder paralysis following a severe back injury sustained when he fell off scaffolding in his early forties. However, the general feeling was that he had a good chance of deriving substantial benefit from the aortic valve replacement and that the risk, while not insignificant, was outweighed by the potential benefits. At no stage was the issue of an advance directive discussed.