My concern about advance directives stems, I suppose, partly from my experience as a family physician.
I have a lot of young patients in my practice who, in the course of a physical exam, show me pretty amazing tattoos in pretty amazing places. At the time they were applied, they were competent and gave consent and thought that's what they wanted. My problem with advanced consent in this situation is that I have this visualization of advanced consent being like a bad tattoo that follows you on through life. It's pretty hard to get rid of, because by the time you wish you could get rid of it, nobody knows you wish you could get rid of it.
All of those tramp stamps, or whatever you want to call them on people, are like advanced directives. I think that's a pretty close analogy: you're in one frame of mind and you make a decision, and who knows what's going to happen when you pass to another frame of mind?
I don't think it's a stretch to refer to cases of complete locked-in syndrome and coma, in which people have woken up and have reported that they were hearing not only every word that was said but were able to recount even such shocking things as abuse on their persons while they were supposedly unresponsive.
As hard as it may be, I think we must always stop ourselves from projecting our own disgust, real and human as it is, to disability onto others. There is no human being who deserves to be called at any time in their earthly existence a shell. There is no human being who deserves to be at any time in their earthly existence described as someone who should raise your disgust by the nature of the personal care that they have to receive.
Very kindly and good people, like Françoise and Nino, are involved in trying to give people what they want. I just want to caution the committee that it is very wise of the existing legislation to shy away from advance directives.