Patients and their families struggle with myriad choices concerning
medical treatments that frequently precede death. Advance directives have
been proposed as a tool to facilitate end-of-life decision making, yet frequently
fail to achieve this goal. In the context of the case of a man with metastatic
cancer for whom an advance directive was unable to prevent a traumatic death,
I review the challenges in creating and implementing advance directives, discuss
factors that can affect clear decision making; including trust, uncertainty,
emotion, hope, and the presence of multiple medical providers; and offer practical
suggestions for physicians. Advance care planning remains a useful tool for
approaching conversations with patients about the end of life. However, such
planning should occur within a framework that emphasizes responding to patient
and family emotions and focuses more on goals for care and less on specific
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 136
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.