The ethics of advance directives: a rehabilitation perspective

Advance directives, including living wills and durable healthcare powers of attorney, have achieved broad acceptance by the healthcare system in the United States. Living wills may include provisions for limitation of care in the event of severe disability. These provisions pose ethical concerns in view of societal misconceptions of the quality of life of individuals with disabilities and the inability of people to predict their own capacity to adapt successfully to a disability. Greater reliance on durable healthcare powers of attorney for situations involving disability is proposed, with an emphasis on improving the education of healthcare proxies designated through this mechanism in the quality of life experienced by people with disabilities.