title: Advance directives affecting medical treatment choices.
abstract: Advance directives theoretically enhance individual autonomy and facilitate treatment decision making at the end of life. There is little empirical evidence to support this, however. Based on a national postal survey of 2172 randomly selected medical practitioners (response rate 73%), this paper examines the effect advance medical directives have on (a) treatment prescribing for terminally ill people and (b) the degree of difficulty practitioners experience in making treatment choices. A hypothetical patient with Alzheimer's disease and an acute life-threatening illness was presented with and without an advance directive. With a directive, respondents were more uniform in their choice of treatment, with 86% choosing as the patient had requested. Difficulty with decision making was also less with the directive, 31% vs 45% with no directive. The data indicate that advance directives do affect practitioners' treatment choices in favor of patient wishes and reduce the difficulty practitioners may experience in making them.
authors.affiliation: Department of Anthropology, University of Western Australia, Nedlands, Western Australia.
authors.forename: C
authors.initials: C
authors.lastname: Waddell
authors.forename: R M
authors.initials: RM
authors.lastname: Clarnette
authors.forename: M
authors.initials: M
authors.lastname: Smith
authors.forename: L
authors.initials: L
authors.lastname: Oldham
mesh_terms: D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000628:therapy; D001315:Australia; D003657:Decision Making; D005260:Female; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy; D010818:Practice Patterns, Physicians'