Eliciting patient preferences in today's health care system

The American Medical Association Council on Ethical and Judicial Affairs recommends that physicians discuss advance directives with their patients and the patients' proxies. The council could have gone further by recognizing the difficulties physicians will encounter in trying to implement its proposal in a managed health care system. There is an undeniable need for caregiver participation in end-of-life planning, but the health care system must recognize and support implementation of the council's recommendations to make that possible. More explicit recognition of this fact on the part of the council would have helped physicians attempt to comply with its recommendations.