Skip to main content
NCBI home page
Journal of Medical Ethics logoLink to Journal of Medical Ethics
. 1999 Feb;25(1):37–41. doi: 10.1136/jme.25.1.37

Relationships between various attitudes towards self-determination in health care with special reference to an advance directive.

M Eisemann 1, J Richter 1
PMCID: PMC479166  PMID: 10070637

Abstract

OBJECTIVES: The subject of patient self-determination in health care has gained broad interest because of the increasing number of incompetent patients. In an attempt to solve the problems related to doctors' decision making in such circumstances, advance directives have been developed. The purpose of this study was to examine relationships between public attitudes towards patient autonomy and advance directives. SUBJECTS AND MAIN OUTCOME MEASURES: A stratified random sample of 600 adults in northern Sweden was surveyed by a questionnaire with a response rate of 78.2%. The subjects were asked about their wish for control of their health care, their concerns about health care, their treatment preferences in a life-threatening situation (both reversible and irreversible), and their attitudes towards the application of advance directives. RESULTS: Numerous relationships between various aspects of self-determination in health care (desire for control, fears of over-treatment, and choice of treatment level) in general and advance directives, in particular, were found. Those who wanted to have a say in their health care (about 94%) also mainly supported the use of an advance directive. CONCLUSIONS: The fact that almost 30% of the respondents were undecided concerning their personal use of advance directives points to a lack of knowledge and to the necessity of education of the public on these issues.

Full text

PDF
37

Selected References

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

  1. Arcangelo V. Should age be a criterion for rationing health care? Nurs Forum. 1994 Jan-Mar;29(1):25–29. doi: 10.1111/j.1744-6198.1994.tb00148.x. [DOI] [PubMed] [Google Scholar]
  2. Broadwell A. W., Boisaubin E. V., Dunn J. K., Engelhardt H. T., Jr Advance directives on hospital admission: a survey of patient attitudes. South Med J. 1993 Feb;86(2):165–168. doi: 10.1097/00007611-199302000-00003. [DOI] [PubMed] [Google Scholar]
  3. Darziņs P., Molloy D. W., Harrison C. Treatment for life-threatening illness. N Engl J Med. 1993 Sep 2;329(10):736–736. doi: 10.1056/NEJM199309023291015. [DOI] [PubMed] [Google Scholar]
  4. Davitt J. K., Kaye L. W. Supporting patient autonomy: decision making in home care. Soc Work. 1996 Jan;41(1):41–50. doi: 10.1093/sw/41.1.41. [DOI] [PubMed] [Google Scholar]
  5. Duffield P., Podzamsky J. E. The completion of advance directives in primary care. J Fam Pract. 1996 Apr;42(4):378–384. [PubMed] [Google Scholar]
  6. Edinger W., Smucker D. R. Outpatients' attitudes regarding advance directives. J Fam Pract. 1992 Dec;35(6):650–653. [PubMed] [Google Scholar]
  7. Elder N. C., Schneider F. D., Zweig S. C., Peters P. G., Jr, Ely J. W. Community attitudes and knowledge about advance care directives. J Am Board Fam Pract. 1992 Nov-Dec;5(6):565–572. [PubMed] [Google Scholar]
  8. 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]
  9. Emanuel L. L., Emanuel E. J. The Medical Directive. A new comprehensive advance care document. JAMA. 1989 Jun 9;261(22):3288–3293. doi: 10.1001/jama.261.22.3288. [DOI] [PubMed] [Google Scholar]
  10. Guyatt G. H., Mitchell A., Molloy D. W., Capretta R., Horsman J., Griffith L. Measuring patient and relative satisfaction with level or aggressiveness of care and involvement in care decisions in the context of life threatening illness. J Clin Epidemiol. 1995 Oct;48(10):1215–1224. doi: 10.1016/0895-4356(95)00024-x. [DOI] [PubMed] [Google Scholar]
  11. Kapp M. B. 'Ageism' and right to die litigation. Med Law. 1994;13(1-2):69–77. [PubMed] [Google Scholar]
  12. Kelner M., Bourgeault I. L., Hébert P. C., Dunn E. V. Advance directives: the views of health care professionals. CMAJ. 1993 Apr 15;148(8):1331–1338. [PMC free article] [PubMed] [Google Scholar]
  13. Kuuppelomäki M. Ethical decision making on starting terminal care in different health-care units. J Adv Nurs. 1993 Feb;18(2):276–280. doi: 10.1046/j.1365-2648.1993.18020276.x. [DOI] [PubMed] [Google Scholar]
  14. Molloy D. W., Guyatt G. H. A comprehensive health care directive in a home for the aged. CMAJ. 1991 Aug 15;145(4):307–311. [PMC free article] [PubMed] [Google Scholar]
  15. Molloy D. W., Guyatt G. H., Alemayehu E., McIlroy W., Willan A., Eisemann M., Abraham G., Basile J., Penington G., McMurdo M. E. Factors affecting physicians' decisions on caring for an incompetent elderly patient: an international study. CMAJ. 1991 Oct 15;145(8):947–952. [PMC free article] [PubMed] [Google Scholar]
  16. Mower W. R., Baraff L. J. Advance directives. Effect of type of directive on physicians' therapeutic decisions. Arch Intern Med. 1993 Feb 8;153(3):375–381. doi: 10.1001/archinte.153.3.375. [DOI] [PubMed] [Google Scholar]
  17. Nuckton T. J., List N. D. Age as a factor in critical care unit admissions. Arch Intern Med. 1995 May 22;155(10):1087–1092. [PubMed] [Google Scholar]
  18. Sam M., Singer P. A. Canadian outpatients and advance directives: poor knowledge and little experience but positive attitudes. CMAJ. 1993 May 1;148(9):1497–1502. [PMC free article] [PubMed] [Google Scholar]
  19. Smedira N. G., Evans B. H., Grais L. S., Cohen N. H., Lo B., Cooke M., Schecter W. P., Fink C., Epstein-Jaffe E., May C. Withholding and withdrawal of life support from the critically ill. N Engl J Med. 1990 Feb 1;322(5):309–315. doi: 10.1056/NEJM199002013220506. [DOI] [PubMed] [Google Scholar]
  20. Thomasma D. C. The ethical challenge of providing healthcare for the elderly. Camb Q Healthc Ethics. 1995 Spring;4(2):148–162. doi: 10.1017/s096318010000582x. [DOI] [PubMed] [Google Scholar]
  21. White B. D., Singer P. A., Siegler M. Continuing problems with patient self-determination. Am J Med Qual. 1993 Winter;8(4):187–193. doi: 10.1177/0885713X9300800405. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Medical Ethics are provided here courtesy of BMJ Publishing Group

RESOURCES