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Advance directives: limitations upon their applicability in elderly care.
1Guy's, Kings and St Thomas' Medical and Dental Schools, Bexley Hospital, Bexley, UK.
International Journal of Geriatric Psychiatry
|December 23, 1999
Summary
Advance directives (ADs) may fail to reflect patient intent, potentially causing suffering. A proposed model helps doctors assess AD validity to ensure patient best interests are met.
Area of Science:
- Medical Ethics
- Geriatric Medicine
- Palliative Care
Background:
- Advance directives (ADs) are legal documents for end-of-life care decisions.
- Increasing AD use raises concerns about their alignment with patient wishes and well-being.
Purpose of the Study:
- To explore potential problems with advance directives.
- To propose a model for assessing the validity of ADs.
Main Methods:
- Discussion of requirements for valid ADs.
- Development of a simple model for physician assessment of AD validity.
Main Results:
- ADs may lead to withholding life-alleviating treatment or cause unintended suffering.
- A model is proposed to help doctors evaluate ADs, focusing on mental capacity and clinical best interests.
Conclusions:
- Doctors need improved understanding of mental capacity limitations.
- Mechanisms for rebutting ADs that conflict with patient best interests are necessary.
- Legislation on ADs is viewed cautiously by the author.
Keywords:
Death and Euthanasia