This issue of the Ethics Network Newsletter is dedicated to our June conference topic on Advance Directives. In looking at the many facets of end-of-life decision making, residents, families and staff bring to the table a host of cultural and religious traditions, many of which are more latent than manifest. The relatively low percentage of residents who arrive at long term facilities with Advance Directives already in hand may be an accurate barometer of the society in which we live. The specific factors may include any number of variables including the difficulty in engaging older individuals in this conversation even though my experience has been that older individuals are less anxious about these matters than popular opinion and their relatives might think! Indeed, the opportunity to relieve family members of burdensome decisions is often an incentive to engage long term care residents in advance directives planning.

Too often, advance directives are seen as end of life decision making only without due consideration to the options they offer in terms of directing life choices and preferences such as ethical wills. I think of advance directives as a thumbnail sketch of individuals’ statement of affirmation. In this issue we present a spectrum of expressions of advance directives and encourage the reader to review the options presented with an open mind and heart. If we personally believe in the value of these decision making tools, it will be easier to facilitate open discussion with residents and family members!

In this issue we initiate a new feature, Ethics Issues, and we are privileged that Dr. Ellen Olson, our esteemed Board Member, has offered her response to an advance directives ethics issue sent to us. We encourage you to share your dilemmas and struggles that we may all become enriched in the process of learning and growing in this area. Your input is always welcome! We enjoy hearing from you.

I would like to thank Dr. Susan Rosendahl for the yeoman's job she has done in coordinating the eclectic and thought inspiring contributions to this issue of the Ethics Network News. Thanks are always in order to Drs. Paulette Sansone and Jeffrey Nichols for their continuous work on behalf of the New York Long Term Care Ethics Network as we enter our 5th year as an organization dedicated to supporting ethical pathways in long term care facilities. We hope you enjoy this issue and we encourage your contributions. Please contact Dr. Rosendahl at 718-796-2444.

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