The soundness of advanced care directives has been undermined by two recent studies in the Archives of Internal Medicine. One research team found that the people designated by patients to make decisions for them “incorrectly predict patients’ end-of-life treatment preferences in one-third of cases”. Even if the surrogates were appointed by the patient or had discussed treatment preferences with them, they were no more accurate.

Another report found that some patients become more tolerant of discomfort, disability and pain as their condition worsens and as time goes on. Furthermore, they cannot accurately predict how they will feel when they are actually confronted with a deterioration in their health. “These changes pose a challenge to advance care planning, which asks patients to predict their future treatment preferences,” say the authors.

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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