Reassessing the Reliability of Advance Directives

Abstract
A competent patient has the right to refuse treatment necessary to sustain life. However, for many end-of-life decisions, we lack direct access to the wishes of a competent patient. Some treatment decisions near the end of life involve patients with severely diminished mental capacity , some involve patients who are unable to communicate , and some involve patients who are simply unable or unwilling to participate in decisionmaking due to the nature or severity of their illness
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