Disadvantages Of Advanced Directives

An advance healthcare directive, also known as a living will or advanced directive, was proposed by Luis Kutner in 1969 as a way to express one’s health wishes before they lose their ability to express these same wishes. This loss of expression may be due to a mental or physical ailment which leads to an inability to communicate one’s wishes. These wishes take a multitude of different forms that help facilitate the health care of an individual who is no longer competent. They make decisions clear when the patient's autonomy and self-determination are compromised. An alternative form of the advanced directive is the use of a health care proxy. In essence, a healthcare proxy is an individual that a patient dictates prior to make healthcare decisions
While a study on advanced directives from Danis et al. concluded that 75 percent of directives are consistent with what is written, there is a paradoxical consistence with the advanced directives not lining up with the current intentions of these patients (Sales). This is due to the lack of flexibility as well as the inner workings of an advanced directive. An advanced directive is a set of instructions made at a certain point in time. These instructions cannot change and are often not updated to the current wishes of a patient. It is difficult to have an up to date will because there is no definitive way to predict that a patient will become incompetent (thus the reason for an advanced directive). A solution to this problem would be to constantly update the living will, but that is an often difficult and cumbersome process. Also, the advanced directive could be updated when one is already mentally ill, thus defeating the purpose of the advanced directive. Finally, health care providers can be unaware of an advanced directive due to their tendency to be behind a significant amount of
Both these principles are often exercised through the use of documentation and forms. However, the multitude of forms such as insurance forms, disability forms, and in this case advanced directives forms, begin to make the patient-physician relationship rehearsed and impersonal (Annas). While it is important to preserve the use of forms and documentation in order to protect patients and make the process more efficient, there should be a consideration in patient-physician relationships. The reason for patient-physician relationships is to form a bond of trust so that the patient respect the expertise and skills of the medical professional. However, if there is a wall of forms and papers being handed to the patient, there is hardly any interaction. Instead of making an patient exam a checklist of different forms and checkups, it should be a conversation between the two. This impersonality between patient and physician can be seen in the flaws of the advanced directive. The advanced directive is used when a patient is incompetent. This is an amazing tool in order to preserve autonomy, but is it truly effective? Often, the advanced directive completely isolates a patient from their physician. Advanced directives are followed strictly and with no consideration for one’s previous competence. An individual could have written in their directive at one point to cut life