Abstract

Advance directives for health care have become widely accepted as a necessary tool to guarantee the civilized management of one’s life during increasingly protracted periods of aging and frail health. The advance directives allow a person with capacity to state their wishes, values, and treatment preferences in advance, prospectively, so that their authentic voice will be heard when their capacity has lapsed. As an ethical matter, a patient’s right to accept or decline particular treatments at the end of life is based on the principle of autonomy. In some cases, however, the principle of beneficence might outweigh the patient’s interest in autonomy, especially if the proposed treatment would reduce the pain or increase functioning without adverse consequences or if the patient were unable to make a rational decision about accepting or declining treatment. Substitute decision makers rely on directions or instructions left by the patient when they had capacity to express and communicate their treatment preferences and goals of care. We find a strong justification for advance care planning. However, there are several critics to advance directives that we will discuss.