A study of the effectiveness of advance directives in a predominantly African American community in Essex County, New Jersey: A new, ethical way of looking at end-of-life decision making in a particular community

African American patients are more wary of the medical system and less likely to execute an advance directive than others. This perspective can be framed in terms of a history of inclusion/exclusion and the concept of the American dream. The limited access of minority groups to the health care system that developed in post World War II America, the rapid development of medical technologies, and the need to deal with these new technologies, including the emergence of the field of bioethics and the use of advance directives, have all contributed to the problem.;After a brief survey of the benefits and drawbacks of utilitarianism and deontological ethics (Kantianism) for members of a minority group making end-of-life decisions and/or executing an advance directive, this study offers John Rawls's theory of "justice as fairness" as a rationale for the individual to make egoistic decisions because those decisions are made in the greater framework of a group (either familial or social) which has at its heart the principle of justice.;Incorporating cultural perspectives that are prominent in the African American community, such as the community's vernacular tradition and a sense of spirituality in end-of-life decision making, would also improve the acceptance of the advance directive document and increase its use in the African American community.;This dissertation presents the results of a series of workshops on advance directives conducted in a predominantly African American community, in East Orange, New Jersey, which showed that, at least for a small group in one small part of a larger community, the majority of respondents agreed that every adult should have an advance directive. However, in keeping with the vernacular tradition, respondents preferred to verbally designate a health care proxy or discuss end-of-life decisions with family and/or their personal physician rather than state their medical treatment preferences in writing.