Structured Advance Planning: Is It Finally Time for Physician Action and Reimbursement?

IF THERE is one striking thing about the advance directives movement, it is the contrast between the overwhelming endorsement of advance directives from all corners of society and their virtual nonuse. Why do they meet with simultaneous deference and diffidence? One possible explanation is that the whole paradigm is wrong-perhaps the autonomy model that motivates the advance directives movement is mistaken. Another possible explanation is that the basis for the movement is right but too much was expected too fast. Perhaps “doing advance directives” is not so simple, and like other medical interventions, advance planning has to develop and find its appropriate place before it is trustworthy. There is not much ground for the more radical explanation that the model of autonomy on which advance directives are founded is flawed. Recently, commentators have pointed out that people are not atomistic. Certainly, if people are like.