Advance directives affecting medical treatment choices

Author(s): Clarnette, R. M., Smith, M., Oldham, L.

Journal/Book: J Palliative Care. 1997; 13: 110 Pine Ave W, Montreal Pq H2W 1R7, Canada. Center Bioethics Clin Res Inst Montreal. 5-8.

Abstract: Advance directives theoretically enhance individual autonomy and facilitate treatment decision making at the end of life. There is little empirical evidence to support this, however. Based on a national postal survey of 2172 randomly selected medical practitioners (response rate 73%), this paper examines the effect advance medical directives have on (a) treatment prescribing for terminally ill people and (b) the degree of difficulty practitioners experience in making treatment choices. A hypothetical patient with Alzheimer's disease and an acute life-threatening illness was presented with and without an advance directive. With a directive, respondents were more uniform in their choice of treatment, with 86% choosing as the patient had requested. Difficulty with decision making was also less with the directive, 31% vs 45% with no directive. The data indicate that advance directives do affect practitioners' treatment choices in favor of patient wishes and reduce the difficulty practitioners may experience in making them.

Note: Article Waddell C, Univ Western Australia, Dept Anthropol, Nedlands, Wa 6907, AUSTRALIA

Keyword(s): LIFE-SUSTAINING TREATMENTS; PHYSICIANS ATTITUDES; LIVING WILLS; HEALTH-CARE; CARDIOPULMONARY-RESUSCITATION; OUTPATIENTS ATTITUDES; ELDERLY OUTPATIENTS; PATIENT PREFERENCES; ILLNESS; TRIAL

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