Motivation and Emotion

, Volume 29, Issue 4, pp 475–496 | Cite as

Imagining the End of Life: On the Psychology of Advance Medical Decision Making

  • Peter H. Ditto
  • Nikki A. Hawkins
  • David A. Pizarro

Near the end of life, individuals often become too ill to express their wishes about the use of life-sustaining medical treatment. Instructional advance directives (i.e., livings wills) are widely advocated as a solution to this problem based on the assumption that healthy people can predict the types of medical treatment they will want to receive if they become seriously ill. In this paper, we review a large body of research from the psychological and medical literatures that challenges this assumption. This research demonstrates that across a wide variety of decision contexts people show limited ability to predict their affective and behavioral reactions to future situations. We outline several ways that policy and law regarding the use of advance directives could be informed by this research, and suggest a number of issues involved in advance medical decision making that could benefit from additional empirical and conceptual attention.


advance directives medical decision making predictive accuracy affective forecasting 


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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Peter H. Ditto
    • 1
    • 4
  • Nikki A. Hawkins
    • 1
    • 2
  • David A. Pizarro
    • 1
    • 3
  1. 1.Department of Psychology and Social BehaviorUniversity of CaliforniaCaliforniaUSA
  2. 2.Present address: Epidemiology and Applied Research Branch, Division of Cancer Prevention and ControlCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Present address: Department of PsychologyCornell UniversityIthacaUSA
  4. 4.Department of Psychology and Social BehaviorUniversity of CaliforniaIrvineUSA

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