Medicine, Health Care and Philosophy

, Volume 19, Issue 4, pp 563–568 | Cite as

The near-failure of advance directives: why they should not be abandoned altogether, but their role radically reconsidered

  • Marta Spranzi
  • Véronique Fournier
Scientific Contribution


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.


Advance directives Near-failure Tensions End-of-life decisions Patient’s autonomy 


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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.University of Versailles-St-Quentin-en-Yvelines (UVSQ)VersaillesFrance
  2. 2.Centre d’éthique clinique, Hôpital CochinAssistance Publique-Hôpitaux de ParisParisFrance

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