Resolving Problems of Advanced Directives and End-of-Life Decision-Making

Abstract

Ten years of experience on an ethics committee of a large hospital has demonstrated that most common problems related to end-of-life decision making result from of a lack of timely discussion regarding advanced directives. Once the patient has a compromised mental status, without prior discussion there is often uncertainty as to what the patient wants. This leads to guilt and either a bias to do everything possible, no matter how burden some or futile, or reluctance to make decisions at all. Chapters throughout this book have stressed early intervention as fundamentally important to prevent serious and chronic problems. In the area of advanced directives this means discussing patients’ wishes well before they become an issue. Logic, realistic thinking, and reliance on lifelong value systems are more likely in volved in decision-making that is not forced by the passions of crisis, anxiety, guilt, or fear. Time for meaningful discussion is often seen as a barrier by doctors. However, in the long run time is saved by avoiding problems, not to mention preventing psychological discomfort. This also preserves patient autonomy even after incapacitation, an important goal of physicians.