Implementing advance directives: a continuing problem for provider organizations

It has been suggested that widespread use of advance directives might encourage systematic rationing of healthcare, especially to the elderly. If a right to die becomes a duty to die, the living will and its progeny have become a Frankenstein monster. Indeed, public statements by state and federal officials that the elderly should be required to have living wills raised a storm of protest in the past. Regardless of true motives, such suggestions tend to be seen by the public as motivated by economics. The organization must be alert to the issues raised by advance directives. Managers are obliged to obey the law. Beyond that, however, they should work to enhance patient autonomy by facilitating preparation and availability of advance directives and surrogate decision making, should that become necessary.