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Advance Directives

Ezekiel J. Emanuel, MD; Linda L. Emanuel, MD; David Orentlicher, MD, JD
JAMA. 1991;266(18):2563. doi:10.1001/jama.1991.03470180063038.
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To the Editor.  —In recent years, there has been growing interest in using advance directives for health care. Together, the Cruzan1 decision and the enactment of the Patient Self-Determination Act of 19902 will greatly expand the use of such documents.However, physicians face problems in implementing advance care documents. The documents are often drafted by lawyers or legislators, and many laws preclude physicians from being proxy decision makers or witnesses to the documents. Further, state-to-state variation in the statutory requirements has created uncertainty among physicians. Patients often fail to bring documents to the attention of their physicians, and, consequently, physicians may not be involved in advance planning. They may be unaware that their patient has an advance care document, and they may not know who is to act as their patient's proxy. All too often physicians are presented with a completed document when it is too late to

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