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Advance directives: what have we learned so far?

L Emanuel1

  • 1Division of Medical Ethics, Harvard Medical School, Boston.

The Journal of Clinical Ethics
|January 1, 1993
PubMed
Summary

Advance directives, specifically instructional directives, are crucial for accurately representing patient wishes in clinical settings. Informed proxy decisions, guided by these directives, ensure patient autonomy and constitutional protection.

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Area of Science:

  • Medical Ethics
  • Health Law
  • Patient Autonomy

Background:

  • Recent focus on advance directives highlights the need for effective patient representation.
  • Existing methods for documenting patient wishes face challenges in clinical application.

Purpose of the Study:

  • To clarify the optimal structure and function of advance directives.
  • To establish best practices for advance care planning that respects patient autonomy.

Main Methods:

  • Analysis of the role of instructional directives in representing patient values.
  • Evaluation of proxy decision-making informed by documented patient preferences.
  • Development of a clinical process for advance planning.

Main Results:

  • Instructional directives, using scenario- and treatment-specific statements, best capture patient wishes.
  • Informed proxy decisions, guided by instructional directives, align with patient preferences.
  • A practical clinical process for advance planning, integrating instructional planning and proxy empowerment, can be constructed.

Conclusions:

  • Instructional directives provide clear evidence of patient wishes, ensuring constitutional protection.
  • Informed proxy decision-making is essential and should be guided by instructional directives.
  • While a robust advance planning process is achievable, widespread and appropriate practice remains a future goal.
Keywords:
Death and Euthanasia

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