It is widely accepted among medical ethicists that competence is a necessary condition for informed consent. In this view, if a patient is incompetent to make a particular treatment decision, the decision must be based on an advance directive or made by a substitute decision-maker on behalf of the patient. We call this the competence model. According to a recent report of the United Nations (UN...

I will start my talk with an actual case. JW, 74, the father of a Catholic physician, who is also an ethicist in a Catholic hospital, suffered a massive stroke that left him paralyzed with receptive and expressive aphasia. His advance directive stated that he did not want mechanical ventilation, nutrition, or hydration if he were to end up in a terminal state. He is now paralyzed and has expres...

The bulk of public interest in advance directives for health care has focused to date upon the living will. This approach is hampered by a narrow focus and a lack of applicability to many of the situations in which guidance is needed. The major value of the living will may prove to be its role in raising the level of public consciousness. The durable power of attorney concept, though not free o...

Background Psychiatric advance directives (PADs) provide a legal means for competent individuals to refuse or consent to future mental health treatment during periods of decisional incapacity. Previous studies have shown high potential demand for PADs but low rates of completion in the United States, despite new laws authorizing PADs in over 20 states. This paper reports the results of the firs...

OBJECTIVE The crisis card is a specific form of psychiatric advance directive, documenting mental clients' treatment preferences in advance of a potential psychiatric crisis. In this paper, we aim to provide insight into implementation issues surrounding the crisis card. METHOD A Dutch crisis-card project formed the scope of this study. Data were collected through interviews with 15 participa...

This paper presents the results of a qualitative interview study exploring English and French physicians' moral perspectives and attitudes towards end-of-life decisions when patients lack capacity to make decisions for themselves. The paper aims to examine the importance physicians from different contexts accord to patient preferences and to explore the (potential) role of advance directives (A...

OBJECTIVES To examine attitudes, experiences, and preferences regarding advance directives (ADs) among adults of all ages. STUDY DESIGN Subjects were surveyed regarding end-of-life (EOL) care wishes. The survey included items measuring knowledge, experiences, and attitudes regarding ADs, as well as preferences toward initiation of discussions. METHODS Subjects included a random sample of pa...

BACKGROUND Advance directives are widely promoted as a means to plan for patients' decisional incapacity, yet there is little evidence of their effectiveness. We devised a study to assess physicians' compliance with hypothetical advance directives and further examine their clinical reasoning. METHODS The study consisted of an analysis of a mailed written survey containing 6 hypothetical cases...

OBJECTIVES To estimate the proportion of seniors in a large health maintenance organization (HMO) who had been asked about their end-of-life care preferences (EOLCPs) by a clinician and who had completed an advance directive (AD). To examine the association of having had an EOLCP discussion and AD completion. SUBJECTS AND METHODS A random sample of HMO members aged 65 years or older were aske...