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

Scientific Contribution

Abstract

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.

Keywords

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

References

  1. Aulisio, M.P. 2014. Advance directives and physician–patient relationship: A surprising metamorphosis. In Advance directives, ed. P. Lack, N. Biller-Andorno, and S. Brauer, 121–132. Rotterdam: Springer.CrossRefGoogle Scholar
  2. Berger, J.T. 2008. Surrogate decision making: Reconciling ethical theory and clinical practice. Annals of Internal Medicine 149: 48–53.CrossRefGoogle Scholar
  3. 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
  4. Bond, C.J., and K. Lowton. 2011. Geriatricians’ views of advance decisions and their use in clinical care in England: qualitative study. Age and Aging 40: 450–456.CrossRefGoogle Scholar
  5. Bonner, S., et al. 2009. Are advance directives legally binding or simply the starting point for discussion on patients’ best interests? British Medical Journal 339: 1230–1234.CrossRefGoogle Scholar
  6. Buchanan, A. 1988. Advance directives and the personal identity problem. Philosophy and Public Affairs 17: 277–302.Google Scholar
  7. Buford, C. 2008. Advancing an advance directive debate. Bioethics 22: 423–430.CrossRefGoogle Scholar
  8. Cohen, A.B. 2014. Overliving. Hastings Center Report 44: 5.CrossRefGoogle Scholar
  9. Doukas, D.J., and L.B. McCullough. 1991. The value history. Journal of Family Practice 32: 145–153.Google Scholar
  10. Doukas, D.J., and J.H. Hardwig. 2003. Using the family covenant in planning end-of-life care: Obligations and promises of patients, families and physicians. Journal of the American Geriatric Society 51: 1155–1158.CrossRefGoogle Scholar
  11. Dunley, S., et al. 2012. Advance directives in community patients with heart failure. Circulation: Cardiovascular Quality and Outcomes 5: 283–289.Google Scholar
  12. Emanuel, L. 2000. How living wills can help doctors and patients talk about dying. British Medical Journal 320: 1618–1619.CrossRefGoogle Scholar
  13. Evans, N., et al. 2012. A critical review of advance directives in Germany: Attitudes, use and health care professionals’ compliance. PEC Patient Education and Counseling 87: 277–288.CrossRefGoogle Scholar
  14. Fagerlin, A., and C.A. Schneider. 2004. Enough. The failure of the living will. Hastings Center Report 34: 30–42. (at 35).CrossRefGoogle Scholar
  15. Fournier, V., et al. 2013. Quelle utilité des directives anticipées pour les médecins? (Are ADs useful for doctors and what for?). Presse Medicale 42: 159–169.CrossRefGoogle Scholar
  16. Horn, R. 2014. I don’t need my patients’ opinion to withdraw treatment: Patient preferences at the end-of-life and physician attitudes towards advance directives in England and France. Medicine, Health Care and Philosophy 17: 425–435.CrossRefGoogle Scholar
  17. Leibniz, G.W. 1952. Theodicy, ed. A. Farrer (trans: Huggard, E.M.). New Haven: Yale University Press. at § 46.Google Scholar
  18. Levi, H.B., and M.J. Green. 2010. Too soon to give up? Reexamining the value of advance directives. American Journal of Bioethics 10: 3–22.CrossRefGoogle Scholar
  19. Nishimura, A., et al. 2007. Patients who complete advance directives and what they prefer. Mayo Clinic Proceedings 82: 1480–1486.CrossRefGoogle Scholar
  20. Nolan, T., et al. 2005. When patients lack capacity: The roles that patients with terminal diagnoses would choose for their physicians and loved ones in making medical decisions. Journal of Pain and Symptom Management  30: 342–353.CrossRefGoogle Scholar
  21. Perkins, H. 2007. Controlling death: The false promise of advance directives. Annals of Internal Medicine 147: 51–57.CrossRefGoogle Scholar
  22. Quill, T. 2000. Initiating end-of-life discussions with seriously ill patients: Addressing the ‘elephant in the room’. JAMA 284: 2502–2507.CrossRefGoogle Scholar
  23. Seymour, J., et al. 2004. Planning for the end of life: The views of older people about advance care statements. Social Science and Medicine 59: 57–68.CrossRefGoogle Scholar
  24. Shaw, D. 2012. A direct advance on advance directives. Bioethics 26: 267–274.CrossRefGoogle Scholar
  25. 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/.
  26. Stone, J. 1994. Advance directives, autonomy and unintended death. Bioethics 8: 223–246.CrossRefGoogle Scholar
  27. Sulmasy, D., et al. 2007. How would terminally ill patients have others make decisions for them in the event of decisional incapacity? A longitudinal study. Journal of the American Geriatric Society 55: 1981–1988.CrossRefGoogle Scholar
  28. Tulsky, J.A. 2005. Beyond advance directives: Importance of communication skills at the end of life. JAMA 294: 359–365.CrossRefGoogle Scholar
  29. Wiesing, U., R.J. Jox, et al. 2010. A new law on advance directives in Germany. Journal of Medical Ethics 36: 779–783.CrossRefGoogle Scholar

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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