Advance directives in dementia care: from instructions to instruments

Advance directives are often regarded as instructions to the doctor about future care. This view is problematic, in that it obliterates that decisions about treatment and care always take place in a concrete situation, and require interpretation and communication. From a hermeneutic perspective, advance directives can be regarded as instruments which do not replace interpretation and communication, but sustain joint decision-making about treatment and care, including the patient and the family in a process of meaning-making.