Abstract
Advance directives frequently demand a certain degree of interpretation by the responsible physician or healthcare team. In implementing advance directives, healthcare professionals find themselves in an area of conflict between respect for autonomy, on the one hand, and paternalism on the other. Legal standards and ethical criteria for assessing the validity of advance directives are introduced and briefly discussed. The ethical criteria presented (accuracy of fit, plausibility/authenticity, lack of contradictions and coherent value system) can serve as important guides for appropriate and consistent interpretation of advance directives. In addition, the effect of advance directives on relationships is addressed from the perspective of the ethics of care.
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Verbally expressed wishes are often taken into account in exploring the presumed wishes of the patient. However, they are clearly less authoritative than a properly executed written document. In the US, medical orders for life-sustaining treatment (MOLST) are treated like advance directives even though they are not initiated by the patient; they merely record the healthcare provider’s conversation with the patient in the form of an order kept in the patient’s medical record and applicable across various healthcare locations, such as hospitals, nursing homes, ambulances, hospices and the patient’s home.
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Trachsel, M., Mitchell, C., Biller-Andorno, N. (2014). Advance Directives Between Respect for Patient Autonomy and Paternalism. In: Lack, P., Biller-Andorno, N., Brauer, S. (eds) Advance Directives. International Library of Ethics, Law, and the New Medicine, vol 54. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7377-6_11
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