| The passage of the Patient Self-Determination Act in the United States in 1990 launched a veritable avalanche of research into the use of advance directives (ADs). ADs are documents on which people record their medical treatment preferences for use in the event that they become incapable of participating in decisions about their own medical care. Although the AD seemed an obvious solution to the problem of self-determination in the face of the oftentimes controversial use of medical technologies to extend life, they were received with a lukewarm response by the public. Researchers have been working on ways to overcome public resistance to ADs for two decades now, but with little to show for their efforts. My research hypothesis is that advance care planning (ACP)---an extension of the AD to include plans for living with disease-must somehow be inimical to the human condition.;My research question is: How might nurses better understand advance care planning in the context of chronic kidney disease? I used a process of analysis based on Hans-Georg Gadamer's philosophical hermeneutics to access both ancestral and contemporary human deliberations on the topic of human responsibility as it applies to technology. Using biblical stories and research conversations with registered nurses (RNs) and with people who have kidney disease, I arrive at the insight that contention is a potentially productive means of dealing with the angst engendered by our responsibility for the technologies we develop and use and that there are three reasons why ACP is an unacceptable means of dealing with that responsibility. First, ACP is presented as an answer to human responsibility toward technology that co-opts human engagement with the original questions of mortality. Second, ACP, inasmuch as it is actualized as a written document, puts peoples' ideas at risk of misinterpretation. Further, the misinterpretation is made powerful and, therefore, dangerous by the perceived authority of the written word. Third, people do not live their lives in the linear temporality that ACP presupposes. I propose that the language of ACP be dropped and that researchers pursue courses of investigation that are more sensitive to the realities of the human condition. |
