Whereas modern medicine has made available technologies that can prolong life, medical science alone cannot answer questions of whether life-sustaining technologies should be used in particular circumstances or whether such technologies are consistent with patients’ goals of care, values, and beliefs about health, life, and death. Therefore, patients should have the opportunity, while they have capacity, to indicate their desires about the use or nonuse of specific treatment modalities and to designate a surrogate (sometimes called healthcare proxy or agent) to make decisions on their behalf if they become incapacitated.
Aging, illness, and death are inevitable. The expanding powers of medical technology to extend life have contributed to cultural anxiety over the reality of natural death while also presenting patients, their families, and healthcare professionals with difficult decisions. The role of the physician is to affirm human life, relieve suffering, and give compassionate, competent care as long as the patient lives.
Advance directives are medically and ethically appropriate. Advance directives should be recommended to all adult patients regardless of health and reviewed and updated periodically. An essential part of an advance directive is the patient’s discussion with designated family or other close associates and the healthcare team about the patient’s values and wishes. Conversations about death, dying, and end-of-life medical care should be a routine part of care. Healthcare professionals should assist patients with advance care planning in accordance with patients’ beliefs, values, and preferences, particularly when they are clearly and consistently expressed.
Advance directives should never be used as a means to physician-assisted suicide or euthanasia. Healthcare professionals should honor their patients’ medically appropriate advance directives and recognize this as an opportunity to respect their dignity.