The Homeric Power of Advance Directives

We shouldn’t underestimate Homer’s hold on us. Whether or not we’ve ever read him, he created many of our ruling memes.
 (b) the decision and statement comply with subsection (6).
 7. See, for instance, Emily Walsh (2020) ‘Cognitive Transformation, Dementia, and the Moral Weight of Advance Directives’, American Journal of Bioethics, 20:8, 54-64; Matilda Carter (2022) ‘Advance Directives: The Principle of Determining Authenticity’ Hastings Center Report 52 (1): 32-41
 (b) has, under a lasting power of attorney created after the advance decision was made, conferred authority on the donee (or, if more than one, any of them) to give or refuse consent to the treatment to which the advance decision relates, or
 (2) An advance decision is not valid if P—
Circe warns Odysseus about the sirens, and how to escape them. She’s very specific about the dangers. The song of the Sirens intoxicates all who hear it. It renders them incapacitous, with calamitous effects:
By Charles Foster
 (b) doing any act he reasonably believes to be necessary to prevent a serious deterioration in P’s condition,
1. Mental Capacity Act 2006 s. 25(1): see text at note 6 below
 (3) P may withdraw or alter an advance decision at any time when he has capacity to do so.
 (a) that treatment is not the treatment specified in the advance decision,
 (b) it is signed by P or by another person in P’s presence and by P’s direction,
 (4) An advance decision is not applicable to the treatment in question if—
 (5) An alteration of an advance decision need not be in writing (unless section 25(5) applies in relation to the decision resulting from the alteration).
‘…if I plead, commanding you to set me free, then lash me faster, rope on pressing rope.’³
 the specified treatment is not to be carried out or continued.
Homeric stories are splendid as stories: they are not always helpful as paradigms. We should beware the Siren voices of advance directives.
 (7) The existence of any lasting power of attorney other than one of a description mentioned in subsection (2)(b) does not prevent the advance decision from being regarded as valid and applicable.
I don’t think it’s fanciful (though it might be ambitious) to suggest that he, and the whole heroic ethos, are partly responsible for our uncritical adoption of a model of autonomy which doesn’t do justice to the sort of creatures we really are. That’s a big claim. I can’t justify it here. But one manifestation of that adoption is our exaggerated respect for advance directives – declarations made when one is capacitous about how one would like to be treated if incapacitous, and which are binding if incapacity supervenes if (in English law) the declaration is ‘valid and applicable.’ ^1.
 while a decision as respects any relevant issue is sought from the court.
 (3) An advance decision is not applicable to the treatment in question if at the material time P has capacity to give or refuse consent to it.
 the decision has effect as if he had made it, and had had capacity to make it, at the time when the question arises whether the treatment should be carried out or continued.
4.Book 12, line 209
(1) If P has made an advance decision which is—
It’s a superb and memorable story – and probably the only advance directive story that most people know. It’s a thoroughgoing endorsement of advance directives. If there had been no directive Odysseus would have rotted in the Sirens’ meadow and Penelope would never have held out against the odious suitors. But it’s misleading. At least in the context of the withdrawal of life-sustaining treatment (where advance directives are most dramatically relevant), it’s unusual to have anticipated the future clinical circumstances and the prognosis and the therapeutic options as accurately as Odysseus anticipated the danger of the Sirens. And, further, we know that when patients are actually facing the situation they so feared, they tend to find that their situation is more bearable than they thought they would.⁷  That didn’t apply to Odysseus.
 (a) it is in writing,
5. Book 12, line 210
2. Book 12, line 50 (all citations are from Robert Fagles’ translation of The Odyssey, Penguin, 2002).
 (2) For the purposes of subsection (1)(a), a decision may be regarded as specifying a treatment or circumstances even though expressed in layman’s terms.
I suspect that some of this respect comes from the earliest and most colourful advance directive story ever: Odysseus and the Sirens.
 (b) any circumstances specified in the advance decision are absent, or
Section 24: Advance decisions to refuse treatment: General
Section 24: Advance decisions to refuse treatment: General
 (b) applicable to the treatment.
 (5) An advance decision is not applicable to life-sustaining treatment unless—
 (b) at that time he lacks capacity to consent to the carrying out or continuation of the treatment,
 (a) providing life-sustaining treatment, or
 (a) valid, and
‘Whoever draws too close, off guard, and catches the Sirens’ voices in the air – no sailing home for him, no wife rising to meet him, no happy children beaming up at their father’s face. The high thrilling song of the Sirens will transfix him, lolling there in their meadow, round them heaps of corpses rotting away, rags of skin shrivelling on their bones….’²
 (4) A withdrawal (including a partial withdrawal) need not be in writing.
 (6) A decision or statement complies with this subsection only if—
Section 25: Validity and applicability of advance decisions
(4) The court may make a declaration as to whether an advance decision—
 (c) is applicable to a treatment.
 (3) A person does not incur liability for the consequences of withholding or withdrawing a treatment from P if, at the time, he reasonably believes that an advance decision exists which is valid and applicable to the treatment.
What happens is, of course, precisely what Odysseus has anticipated. Odysseus hears the ‘ravishing voices’ of the Sirens and his heart ‘throb[s] to listen longer.’ ⁴ He ‘signal[s]the crew with frowns to set [him] free’, but they row all the harder, and Perimedes and Eurylochus bind him tighter.⁵