As the title suggests, Shepherd's article argues that questions about medical care at the end of life should be approached like other important questions about medical care—with consideration to patients’ wishes, values, interests, and relationships, and without special laws, special burdens of proof, or unique requirements for documentation. She contends that reducing legal distinctions between end-of-life decisions and other health care decisions can bring efficacious changes to both sorts of decision making processes.
The heart of the article is a "blueprint for reform" through the following eight general principles that should guide the law relating to all health care decisions, including those we now think of as end-of-life decisions.
- Principle 1: Respect and Care for the Patient Require Balancing Rather Than Rigidly Prioritizing Among Patient Instructions, Wishes, Values, and Interests
- Principle 2: All Patients Should Have a Surrogate Decision Maker, and the Same Standards of Decision Making Should Apply to All Surrogate Decision Makers
- Principle 3: Requirements for Advance Documentation by Patients Should Be Minimal
- Principle 4: Binding Pre-Commitments Should Be Allowed Only Sparingly and for Compelling Reasons; They Should Not Be Required or Encouraged
- Principle 5: Rushed Decisions That People Do Not or Should Not Want to “Live Like That” Should Be Avoided
- Principle 6: Communication About Health Care Decisions Should Be Encouraged but Not Scripted by Law
- Principle 7: Appropriate Safeguards to Protect Patients with Diminished Capacity Are Needed
- Principle 8: Relief of Pain and Suffering Should Always Be Permitted and Considered an Important Goal of Care