From advance directives to advance care planning: current legal status, ethical rationales and a new research agenda

Intern Med J. 2005 Sep;35(9):563-6. doi: 10.1111/j.1445-5994.2005.00915.x.


This paper uses a case example to review the current legal status of advance directives, as well as their ethical rationale. We draw attention to ongoing efforts to institutionalize advance directives, and to some of the tractable and intractable reasons why advance directives are ineffective. We then introduce the concept of advance care planning, and argue that we should not assume that advance care directives have a place in this process. We conclude by offering three reasons why this assumption may operate, and by suggesting that contingency and uncertainty may sometimes overwhelm all rational approaches to medical care.

Publication types

  • Case Reports

MeSH terms

  • Advance Care Planning* / ethics
  • Advance Care Planning* / legislation & jurisprudence
  • Aged, 80 and over
  • Cerebral Hemorrhage / therapy
  • Decision Making
  • Female
  • Humans
  • Living Wills* / ethics
  • Living Wills* / legislation & jurisprudence
  • Personal Autonomy