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. 1996 Oct;89(10):568–570. doi: 10.1177/014107689608901008

Advance directives: from the perspective of the patient and the physician.

S C Johnston 1, S C Johnson 1
PMCID: PMC1295958  PMID: 8976892

Abstract

American physicians and patients share some common ground in their perspectives on advance directives. The majority in both groups strongly endorse the use of these documents. Both groups believe it is the physician's responsibility to initiate the discussion about advance directives. However, a gap between the two perspectives can be defined. In end-of-life decision making, physicians balance the ethical principle of patient autonomy with other principles such as appropriate withholding of care in the setting of futility. Patients' preferences for end-of-life care are most influenced by expected outcomes. Physicians tend to be selective in their indications for initiating a discussion about advance directives, according to clinical factors. In contrast, most patients want to discuss advance directives with their physician under all circumstances.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brunetti L. L., Carperos S. D., Westlund R. E. Physicians' attitudes towards living wills and cardiopulmonary resuscitation. J Gen Intern Med. 1991 Jul-Aug;6(4):323–329. doi: 10.1007/BF02597430. [DOI] [PubMed] [Google Scholar]
  2. Danis M., Garrett J., Harris R., Patrick D. L. Stability of choices about life-sustaining treatments. Ann Intern Med. 1994 Apr 1;120(7):567–573. doi: 10.7326/0003-4819-120-7-199404010-00006. [DOI] [PubMed] [Google Scholar]
  3. Danis M., Southerland L. I., Garrett J. M., Smith J. L., Hielema F., Pickard C. G., Egner D. M., Patrick D. L. A prospective study of advance directives for life-sustaining care. N Engl J Med. 1991 Mar 28;324(13):882–888. doi: 10.1056/NEJM199103283241304. [DOI] [PubMed] [Google Scholar]
  4. Davidson K. W., Hackler C., Caradine D. R., McCord R. S. Physicians' attitudes on advance directives. JAMA. 1989 Nov 3;262(17):2415–2419. [PubMed] [Google Scholar]
  5. Ebell M. H., Doukas D. J., Smith M. A. The do-not-resuscitate order: a comparison of physician and patient preferences and decision-making. Am J Med. 1991 Sep;91(3):255–260. doi: 10.1016/0002-9343(91)90124-g. [DOI] [PubMed] [Google Scholar]
  6. Emanuel L. L., Barry M. J., Stoeckle J. D., Ettelson L. M., Emanuel E. J. Advance directives for medical care--a case for greater use. N Engl J Med. 1991 Mar 28;324(13):889–895. doi: 10.1056/NEJM199103283241305. [DOI] [PubMed] [Google Scholar]
  7. Emanuel L. L., Emanuel E. J., Stoeckle J. D., Hummel L. R., Barry M. J. Advance directives. Stability of patients' treatment choices. Arch Intern Med. 1994 Jan 24;154(2):209–217. doi: 10.1001/archinte.154.2.209. [DOI] [PubMed] [Google Scholar]
  8. Everhart M. A., Pearlman R. A. Stability of patient preferences regarding life-sustaining treatments. Chest. 1990 Jan;97(1):159–164. doi: 10.1378/chest.97.1.159. [DOI] [PubMed] [Google Scholar]
  9. Fried T. R., Stein M. D., O'Sullivan P. S., Brock D. W., Novack D. H. Limits of patient autonomy. Physician attitudes and practices regarding life-sustaining treatments and euthanasia. Arch Intern Med. 1993 Mar 22;153(6):722–728. doi: 10.1001/archinte.153.6.722. [DOI] [PubMed] [Google Scholar]
  10. Gamble E. R., McDonald P. J., Lichstein P. R. Knowledge, attitudes, and behavior of elderly persons regarding living wills. Arch Intern Med. 1991 Feb;151(2):277–280. [PubMed] [Google Scholar]
  11. Goetzler R. M., Moskowitz M. A. Changes in physician attitudes toward limiting care of critically ill patients. Arch Intern Med. 1991 Aug;151(8):1537–1540. [PubMed] [Google Scholar]
  12. Greco P. J., Schulman K. A., Lavizzo-Mourey R., Hansen-Flaschen J. The Patient Self-Determination Act and the future of advance directives. Ann Intern Med. 1991 Oct 15;115(8):639–643. doi: 10.7326/0003-4819-115-8-639. [DOI] [PubMed] [Google Scholar]
  13. Hare J., Nelson C. Will outpatients complete living wills? A comparison of two interventions. J Gen Intern Med. 1991 Jan-Feb;6(1):41–46. doi: 10.1007/BF02599390. [DOI] [PubMed] [Google Scholar]
  14. Johnston S. C., Pfeifer M. P., McNutt R. The discussion about advance directives. Patient and physician opinions regarding when and how it should be conducted. End of Life Study Group. Arch Intern Med. 1995 May 22;155(10):1025–1030. doi: 10.1001/archinte.155.10.1025. [DOI] [PubMed] [Google Scholar]
  15. Kohn M., Menon G. Life prolongation: views of elderly outpatients and health care professionals. J Am Geriatr Soc. 1988 Sep;36(9):840–844. doi: 10.1111/j.1532-5415.1988.tb04270.x. [DOI] [PubMed] [Google Scholar]
  16. La Puma J., Orentlicher D., Moss R. J. Advance directives on admission. Clinical implications and analysis of the Patient Self-Determination Act of 1990. JAMA. 1991 Jul 17;266(3):402–405. doi: 10.1001/jama.266.3.402. [DOI] [PubMed] [Google Scholar]
  17. Lawrence V. A., Clark G. M. Cancer and resuscitation. Does the diagnosis affect the decision? Arch Intern Med. 1987 Sep;147(9):1637–1640. doi: 10.1001/archinte.147.9.1637. [DOI] [PubMed] [Google Scholar]
  18. Lo B., McLeod G. A., Saika G. Patient attitudes to discussing life-sustaining treatment. Arch Intern Med. 1986 Aug;146(8):1613–1615. [PubMed] [Google Scholar]
  19. Lo B., Saika G., Strull W., Thomas E., Showstack J. 'Do not resuscitate' decisions. A prospective study at three teaching hospitals. Arch Intern Med. 1985 Jun;145(6):1115–1117. [PubMed] [Google Scholar]
  20. Markson L. J., Fanale J., Steel K., Kern D., Annas G. Implementing advance directives in the primary care setting. Arch Intern Med. 1994 Oct 24;154(20):2321–2327. [PubMed] [Google Scholar]
  21. Miller D. L., Gorbien M. J., Simbartl L. A., Jahnigen D. W. Factors influencing physicians in recommending in-hospital cardiopulmonary resuscitation. Arch Intern Med. 1993 Sep 13;153(17):1999–2003. [PubMed] [Google Scholar]
  22. Morrison R. S., Morrison E. W., Glickman D. F. Physician reluctance to discuss advance directives. An empiric investigation of potential barriers. Arch Intern Med. 1994 Oct 24;154(20):2311–2318. [PubMed] [Google Scholar]
  23. Murphy D. J., Burrows D., Santilli S., Kemp A. W., Tenner S., Kreling B., Teno J. The influence of the probability of survival on patients' preferences regarding cardiopulmonary resuscitation. N Engl J Med. 1994 Feb 24;330(8):545–549. doi: 10.1056/NEJM199402243300807. [DOI] [PubMed] [Google Scholar]
  24. Reilly B. M., Magnussen C. R., Ross J., Ash J., Papa L., Wagner M. Can we talk? Inpatient discussions about advance directives in a community hospital. Attending physicians' attitudes, their inpatients' wishes, and reported experience. Arch Intern Med. 1994 Oct 24;154(20):2299–2308. [PubMed] [Google Scholar]
  25. Sachs G. A., Stocking C. B., Miles S. H. Empowerment of the older patient? A randomized, controlled trial to increase discussion and use of advance directives. J Am Geriatr Soc. 1992 Mar;40(3):269–273. doi: 10.1111/j.1532-5415.1992.tb02081.x. [DOI] [PubMed] [Google Scholar]
  26. Steinbrook R., Lo B., Moulton J., Saika G., Hollander H., Volberding P. A. Preferences of homosexual men with AIDS for life-sustaining treatment. N Engl J Med. 1986 Feb 13;314(7):457–460. doi: 10.1056/NEJM198602133140730. [DOI] [PubMed] [Google Scholar]
  27. Stolman C. J., Gregory J. J., Dunn D., Levine J. L. Evaluation of patient, physician, nurse, and family attitudes toward do not resuscitate orders. Arch Intern Med. 1990 Mar;150(3):653–658. [PubMed] [Google Scholar]
  28. Sugarman J., Kass N. E., Faden R. R., Goodman S. N. Catalysts for conversations about advance directives: the influence of physician and patient characteristics. J Law Med Ethics. 1994 Spring;22(1):29–35. doi: 10.1111/j.1748-720x.1994.tb01272.x. [DOI] [PubMed] [Google Scholar]
  29. Teno J. M., Lynn J., Phillips R. S., Murphy D., Youngner S. J., Bellamy P., Connors A. F., Jr, Desbiens N. A., Fulkerson W., Knaus W. A. Do formal advance directives affect resuscitation decisions and the use of resources for seriously ill patients? SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Clin Ethics. 1994 Spring;5(1):23–30. [PubMed] [Google Scholar]
  30. Wachter R. M., Luce J. M., Hearst N., Lo B. Decisions about resuscitation: inequities among patients with different diseases but similar prognoses. Ann Intern Med. 1989 Sep 15;111(6):525–532. doi: 10.7326/0003-4819-111-6-525. [DOI] [PubMed] [Google Scholar]

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