Editor—Doyal has written about the need for education and training of doctors about advance directives.1 Because of the Law Commission’s proposal to give advance directives a statutory basis2 doctors must understand the legal implications.3 The BMA has published a code of practice to guide health professionals,4 but uncertainty still exists. At the BMA’s conference in Brighton in 1996 a motion proposing that “advance directives should be specific and clearly defined” was defeated. Little has been published about doctors’ knowledge of advance directives; in a survey of general practitioners in South Australia, where advance directives have legal force under the Natural Death Act 1983, Ashby et al showed that lack of knowledge was an obstacle to the effective use of living wills.5
We conducted a postal survey in Dorset of doctors’ knowledge of advance directives. We sent a 10 item questionnaire (copies available from us) to 80 hospital doctors (22 registrars, 58 consultants) based at four NHS trusts and to 80 general practitioners. Forty two (53%) hospital doctors and 47 (59%) general practitioners replied, with an overall response rate of 56% (89/160). None of the NHS trusts had a policy on advance directives, and only three general practitioners worked in a practice with a policy.
Seventeen (40%) hospital doctors and 21 (45%) general practitioners had not heard of the BMA’s publication Advance Statements About Medical Treatment. Few respondents (20) knew that patients in a persistent vegetative state could have treatment withdrawn only by the court. Only 44 respondents knew that an advance directive was invalid in the case of a mentally ill patient receiving treatment under the Mental Health Act. Fifty six respondents would have voted in favour of the motion proposed at the BMA’s conference in 1986. Twenty seven (64%) hospital doctors said that they would be able to discuss advance directives with a patient, but only 20 (47%) said that they would be able to assess a person’s mental capacity to make one; the corresponding figures for general practitioners were 40 (82%) and 37 (76%) respectively. Most (76) respondents indicated that they would like more guidance about advance directives.
The message is clear: the medical profession needs to address how best to inform and train doctors about advance directives.
References
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