Championing Autonomy Through Advance Directive Advocacy

Abstract: Advance healthcare directives (AHDs) can help guide decision making when patients are unable to communicate their wishes, which can potentially reduce conflict. Providers can refer to patients’ AHDs to tailor recommendations and guidance offered to surrogate decision-makers (SDMs), and in that way preserve patient autonomy. However, documented wishes are not always followed, whether due to decision-makers being unaware of the AHD, actively disregarding the AHD, or due to the AHD being vague or confusing.

I propose that one way clinical ethicists can advocate for patient autonomy is by encouraging healthcare providers to complete their own AHDs. Having an AHD will not only be personally beneficial to the provider, but can also set the tone for their discussions with patients about why and how to complete an AHD. Additionally, I theorize that this approach may increase providers’ empathy-driven efforts to implement their patients’ AHD as they would want their own wishes to be followed.

Informal polling indicates that although many healthcare providers wish to have a detailed AHD, they have not yet created one. I suggest a proactive institutional campaign that includes workshops specifically designed for healthcare providers. These workshops will include: 1) information about how to create AHDs that are relevant and valuable to healthcare providers; 2) resources for talking to potential SDMs and others about healthcare wishes and AHDs; 3) opportunities for providers to complete their own AHD, if they so choose; and 4) training about how AHDs can be used to reduce conflict and preserve patient autonomy.

Keywords: Autonomy, Advance healthcare directives