ADVANCE DIRECTIVES AFFECTING MEDICAL-TREATMENT CHOICES

Advance directives theoretically enhance individual autonomy and facil itate treatment decision making at the end of life. There is little em pirical 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 o n (a) treatment prescribing for terminally ill people and (b) the degr ee of difficulty practitioners experience in making treatment choices. A hypothetical patient with Alzheimer's disease and an acute life-thr eatening illness was presented with and without an advance directive. With a directive, respondents were more uniform in their choice of tre atment, with 86% choosing as the patient had requested. Difficulty wit h decision making was also less with the directive, 31% vs 45% with no directive. The data indicate that advance directives do affect practi tioners' treatment choices in favor of patient wishes and reduce the d ifficulty practitioners may experience in making them.