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J R Soc Med 1996;89:568-570
© 1996 Royal Society of Medicine

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Journal of the Royal Society of Medicine, Vol 89, Issue 10 568-570, Copyright © 1996 by Royal Society of Medicine

ORIGINAL ARTICLES

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

SC Johnston and SC Johnson
Department of Internal Medicine, University of Kansas School of Medicine-Wichita 67214-3199, USA.

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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