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The near-failure of advance directives: why they should not be abandoned altogether, but their role radically reconsidered

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Abstract

Advance directives (ADs) have been hailed for two decades as the best way to safeguard patients’ autonomy when they are totally or partially incompetent. In many national contexts they are written into law and they are mostly associated with end-of-life decisions. Although advocates and critics of ADs exchange relevant empirical and theoretical arguments, the debate is inconclusive. We argue that this is so for good reasons: the ADs’ project is fraught with tensions, and this is the reason why they are both important and deeply problematic. We outline six such tensions, and conclude with some positive suggestions about how to better promote patients’ autonomy in end-of-life decision. We argue that ADs should continue to be an option but they cannot be the panacea that they are expected to be.

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Notes

  1. In this paper, we shall only be concerned with treatment-specific ADs, to the exclusion of more generally conceived living wills and power of attorneys to name healthcare proxies.

  2. The End-of life act, n. 2005-370 of April 22nd, 2005. The revised version of the law has been approved on February 2nd 2016. Article L. 1111-11 deals with advance directives and establishes that they are binding for doctors provided that the patient’s actual medical condition corresponds to what has been described in the ADs. (https://www.legifrance.gouv.fr/affichCodeArticle.do;jsessionid=BCA0AF498C6201146692DFD582E635BE.tpdila18v_3?idArticle=LEGIARTI000031972302&cidTexte=LEGITEXT000006072665&categorieLien=id&dateTexte=).

  3. For a useful and up-to-date review of data concerning the writing of AD, see Aulisio (2014) and Perkins (2007). For a comparative European perspective see Horn (2014).

  4. The main results of our clinical ethics study are reported and discussed in: Fournier et al. (2013). More detailed results are available in: Spranzi and Favereau (2013) (http://www.ethique-clinique.com).

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Authors and Affiliations

  1. University of Versailles-St-Quentin-en-Yvelines (UVSQ), Versailles, France

    Marta Spranzi

  2. Centre d’éthique clinique, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France

    Marta Spranzi & Véronique Fournier

Authors
  1. Marta Spranzi
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  2. Véronique Fournier
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Correspondence to Véronique Fournier.

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Spranzi, M., Fournier, V. The near-failure of advance directives: why they should not be abandoned altogether, but their role radically reconsidered. Med Health Care and Philos 19, 563–568 (2016). https://doi.org/10.1007/s11019-016-9704-7

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  • DOI: https://doi.org/10.1007/s11019-016-9704-7

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