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The advance directive--a review

C Y Hong1, L G Goh, H P Lee

  • 1Department of Community, Occupational and Family Medicine, National University of Singapore, Singapore.

Singapore Medical Journal
|August 1, 1996
PubMed
Summary
This summary is machine-generated.

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Advance directives allow individuals to outline future healthcare preferences. Evolving since 1967, these legal documents guide medical decisions but require clear implementation to avoid ethical and practical challenges.

Area of Science:

  • Medical Ethics
  • Health Law
  • Patient Autonomy

Background:

  • Advance directives enable competent individuals to specify future healthcare wishes.
  • Landmark cases like Karen Ann Quinlan and Nancy Cruzan highlight their importance.
  • These documents aid complex healthcare decision-making for patients, families, and clinicians.

Purpose of the Study:

  • To review the historical development of advance directives.
  • To analyze the evolution of advance directive legislation and practice in America.
  • To examine the benefits and challenges associated with advance directives.

Main Methods:

  • Literature review tracing the history of advance directives from 1967.
  • Analysis of key legal cases and legislative changes (e.g., California Natural Death Act 1976).
Keywords:
Death and Euthanasia

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  • Examination of ethical considerations and potential implementation issues.

    • Main Results:

    • Advance directives have evolved significantly since their inception, expanding scope and types (e.g., proxy directives).
    • Legislation has broadened definitions (e.g., "terminal") and patient choices regarding treatment.
    • Potential conflicts arise from vague terminology, ethical considerations, and economic factors.

    Conclusions:

    • When properly implemented, advance directives clarify patient values regarding life, death, and medical care.
    • Vague directives or uncertain prognoses can confuse caregivers.
    • Improper use can lead to decisions based on economic factors, bias, or physician values rather than patient preferences.