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

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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.

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Notes

  1. This is particularly likely given the provisions of the Patient Self-Determination Act, which requires that all individuals be provided with the materials to complete advance directives upon hospital admission.

  2. A less radical approach would be to provide individuals with actuarial data to assist them in making their own decisions. Ultimately, it must be noted that the feasibility of developing an actuarial approach with an acceptable level of accuracy is highly speculative, and even if it were possible, institutionalizing such an approach to end-of-life decision making would be extremely controversial. We discuss it here primarily to highlight the fact that using empirical research to inform the development of policy and law can lead to novel solutions to traditional problems.

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Correspondence to Peter H. Ditto.

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Dr. Pizarro's work on the paper was conducted while he was a postdoctoral fellow supported by National Institute of Mental Health, National Research Service Award 5 T32 MH19958.

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Ditto, P.H., Hawkins, N.A. & Pizarro, D.A. Imagining the End of Life: On the Psychology of Advance Medical Decision Making. Motiv Emot 29, 475–496 (2005). https://doi.org/10.1007/s11031-006-9017-x

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