Do you mean when it's being triggered and used? What's really important is we need to think of these differently in terms of the procedural safeguards and what the documents would look like and what the processes would be.
There are indeed failings in the advance directive regimes. I'm not looking to graft this on to those. I think what you would do is have the person write a document in collaboration with a clinician. It's a written arrangement—an agreement between people—and it would set out what the person considers to be intolerable suffering and objective criteria to determine whether those criteria are met.
For example, my intolerable suffering might be about a loss of personal identity, personal integrity and my own conception of dignity. What I couldn't do is just say, “When I no longer have personal integrity.” How can somebody else assess that? What they can assess, for instance, is if I say I can no longer name my spouse or children any day at all for two weeks straight. I could say that, or I could say that when I am at stage 7 dementia. That is an objectively assessable condition that I tie to my personal determination of what constitutes intolerable suffering.
What would happen is that somebody would say, “This person has lost decision-making capacity. There is an advance request. Here are the objectively assessable conditions for the provision. Have they been met?” The clinician would be able to assess that.