Health Care Analysis

, Volume 22, Issue 1, pp 59–72 | Cite as

Advance Directives in English and French Law: Different Concepts, Different Values, Different Societies

Original Article


In Western societies advance directives are widely recognised as important means to extend patient self-determination under circumstances of incapacity. Following other countries, England and France have adopted legislation aiming to clarify the legal status of advance directives. In this paper, I will explore similarities and differences in both sets of legislation, the arguments employed in the respective debates and the socio-political structures on which these differences are based. The comparison highlights how different legislations express different concepts emphasising different values accorded to the duty to respect autonomy and to protect life, and how these differences are informed by different socio-political contexts. Furthermore each country associates different ethical concerns with ADs which raise doubts about whether these directives are a theoretical idea which is hardly applicable in practice.


Advance directives Autonomy Welfare Solidarity Responsibility England France 



This paper forms part of wider research comparing policies, implementations and attitudes towards advance directives in England and France funded by an EU grant for the FP7 project, “Advance decision-making: Advance directives and proxy decision-making in France and in England” (ADVANCED - FP7-PEOPLE-2009-IEF-254825). An earlier version of the paper was presented at a workshop supported by the Institute for Advanced Studies and organised by the Centre for Ethics in Medicine, University of Bristol, “LEAP—Advance decision-making at the end-of-life”, in September 2011. I am grateful to the participants who contributed to discussion of the paper and to Kerry Gutridge for reviewing the text. I would particularly like to thank Richard Huxtable for his support and detailed comments on earlier drafts. Finally, I would like to thank the anonymous referees for critical comments and suggestions that led to improvements in the quality of this paper.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Centre for Ethics in MedicineUniversity of BristolBristolUK

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