Article Text

Advance decisions: worth the paper they are (not) written on?
  1. Richard Huxtable
  1. Centre for Ethics in Medicine, School of Social and Community Medicine, Bristol, UK
  1. Correspondence to Professor Richard Huxtable, R.Huxtable{at}


Law and policy in England and Wales permit individuals to set down, in advance of future incapacity, their wishes as to what medical treatment they would want—and, particularly, not want—to receive in the future. A House of Lords Select Committee has, however, recently found that the reality of advance decision-making does not match the theory. In this article, I consider eight problems with the practice and the theory, which suggest that so-called ‘advance directives’ can be non-existent, uninformed, imprecise, unavailable, inadequate, unpredictable, unauthoritative and illegitimate. I nevertheless conclude that many—maybe all—of the problems can be overcome, such that advance decision-making need not be so problematic after all.

  • Ethical issues
  • Legal issues
  • Advance care planning
  • Do not resuscitate orders
  • End of life decisions

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