Advance directives

Linda L. Emanuel*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

27 Scopus citations


Most patients want some control over their medical care, including - or even especially - when they are too sick to participate in decisions. Clinicians who have to make decisions for patients who are unable to participate often would appreciate guidance from patients' wishes. Advance care planning responds to these needs. The process provides for discussions about goals in different scenarios and allows inclusion of the family and physician as well as the patient. It helps to have the patient and family complete validated worksheets that walk them through the various considerations and result in expressions of preference that are clinically meaningful. For the clinician, scenario-based goals for care and personal thresholds for when desired care shifts from primarily cure-oriented to primarily palliative are the most useful features to know about. The patient and family should do most of the discussing on their own time; the physician and team should coordinate to screen for problems and ensure agreement. Ideally, this should occur over the course of regular clinical encounters, with some dedicated time for the topic at suitable intervals.

Original languageEnglish (US)
Pages (from-to)187-198
Number of pages12
JournalAnnual review of medicine
StatePublished - 2008


  • Advance care planning
  • Goals
  • Medical directives
  • Proxy
  • Scenarios
  • Thresholds

ASJC Scopus subject areas

  • General Biochemistry, Genetics and Molecular Biology


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