ABSTRACT
This chapter describes the history and definitions of advance directives, the theories underlying the concept, research findings regarding the execution of advance directives, their content and their usage in end-of-life decision making and the policy implications of the United States' experience with advance directives. Advance directives are documents in which people can record their wishes for health-care decisions in the event that they lose the ability to make or communicate decisions in the future. Advance care planning refers to ongoing discussions between patients and their health-care providers that clarify their values and wishes concerning end-of-life care, rather than specifying preferences for specific scenarios. The story of advance directives in the United States offers a fascinating case study of the interplay between philosophy, theory, economic considerations, public policy, and actual clinical practice. The research has questioned the actual impact of advance directives on care in the hospital and in the nursing home.
