Advance directives for medical care — A case for greater use

Linda L. Emanuel, Michael J. Barry, John D. Stoeckle, Lucy M. Ettelson, Ezekiel J. Emanuel

Research output: Contribution to journalArticlepeer-review

649 Scopus citations


Background. Advance directives for medical care and the designation of proxy decision makers to guide medical care after a patient has become incompetent have been widely advocated but little studied. We investigated the attitudes of patients toward planning, perceived barriers to such planning, treatment preferences in four hypothetical scenarios, and the feasibility of using a particular document (the Medical Directive) in the outpatient setting to specify advance directives. Methods. We surveyed 405 outpatients of 30 primary care physicians at Massachusetts General Hospital and 102 members of the general public in Boston and asked them as part of the survey to complete the Medical Directive. Results. Advance directives were desired by 93 percent of the outpatients and 89 percent of the members of the general public (P>0.2). Both the young and the healthy subgroups expressed at least as much interest in planning as those older than 65 and those in fair-to-poor health. Of the perceived barriers to issuing advance directives, the lack of physician initiative was among the most.

Original languageEnglish (US)
Pages (from-to)889-895
Number of pages7
JournalNew England Journal of Medicine
Issue number13
StatePublished - Mar 28 1991

ASJC Scopus subject areas

  • General Medicine


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