Often, many experts contend, the medical and legal communities do not govern the advanced directives, the state legislatures govern them, and they have little understanding of the real issues and ethics surrounding these issues. As one expert notes, "In actual practice, evidence suggests that patients' ability to have their wishes regarding the prohibition of life-sustaining treatment honored may be impeded in states where natural death legislation exists" (Kapp 77)
However, many circumstances challenge these orders, and the ethics of carrying them out are sometimes convoluted and questionable. For example, one cited case involved a 21-year-old pregnant female diagnosed with "PCP (pneumocystis carinii pneumonia), right parietal infarct (a blood clot in her brain) with left hemiplegia, and CMV (cytomegalovirus, an infection similar to mononucleosis)" (Kuczewski and Pinkus 73)
C. reporter notes, "the American Medical Association estimates that 15% of the population has filled out some type of advance directive specifying what medical treatment they should be given if they are unable to offer guidance, or who will decide for them" (Moran 10)
' For the physician the case was hopeless. Eventually, a court had to decide the issue and allow the woman to die (Radest 88)