The near-failure of advance directives: why they should not be abandoned altogether, but their role radically reconsidered
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Advance directives (ADs) have been hailed for two decades as the best way to safeguard patients’ autonomy when they are totally or partially incompetent. In many national contexts they are written into law and they are mostly associated with end-of-life decisions. Although advocates and critics of ADs exchange relevant empirical and theoretical arguments, the debate is inconclusive. We argue that this is so for good reasons: the ADs’ project is fraught with tensions, and this is the reason why they are both important and deeply problematic. We outline six such tensions, and conclude with some positive suggestions about how to better promote patients’ autonomy in end-of-life decision. We argue that ADs should continue to be an option but they cannot be the panacea that they are expected to be.
KeywordsAdvance directives Near-failure Tensions End-of-life decisions Patient’s autonomy
- Berlin, I. 1969. Two concepts of liberty. In Four essays on liberty, 118–162. London: Oxford University Press. P. Lack et al. Advance directives. Google Scholar
- Buchanan, A. 1988. Advance directives and the personal identity problem. Philosophy and Public Affairs 17: 277–302.Google Scholar
- Doukas, D.J., and L.B. McCullough. 1991. The value history. Journal of Family Practice 32: 145–153.Google Scholar
- Dunley, S., et al. 2012. Advance directives in community patients with heart failure. Circulation: Cardiovascular Quality and Outcomes 5: 283–289.Google Scholar
- Leibniz, G.W. 1952. Theodicy, ed. A. Farrer (trans: Huggard, E.M.). New Haven: Yale University Press. at § 46.Google Scholar
- Spranzi, M., and E. Favereau. 2013. Les directives anticipées chez les personnes de plus de 75 ans. Paris: AP-HP, Ethique: regards croisés. http://ethique-clinique.com/categorie/publications/brochures/.