Editorial

Commentary on “Advance Directives to Physicians: What Every Physician Should Know”

Authors: G. Richard Holt, MD, MSE, MPH, MABE

Abstract

Dr Klugman has nicely addressed the vitally important issue of advance care planning by patients, providing needed information to physicians about all aspects of these documents.1 Virtually all physicians, at some point in their careers, will be faced with caring for a patient at the end of his or her life. This challenge is more commonly encountered by primary care physicians, geriatricians, oncologists, critical care physicians, neurologists, and psychiatrists, but the situation is not limited to them. Many decisions in the clinical encounter are now addressed in what is known as “shared decision making,” in which there is discourse between physician and patient, allowing the physician to provide insight and information based on experience, the physician’s knowledge of the available evidence regarding the health condition, and obligations of beneficence and nonmaleficence, while allowing the patient to make the final decisions based on his or her values and preferences. Most patients will likely rely upon the physician to initiate a conversation about end-of-life decisions, or at least about beginning to think in terms of identifying preferences through the instrument of an advance care plan. Such discussions are not a one-time affair but must be reexamined over time with the patient and his or her family.

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References

1. Klugman CM. Advance directives to physicians: what every physician should know. South Med J 2012; 105: 289–291.
 
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4. Holt GR. Timely diagnosis and disclosure of Alzheimer disease gives patients opportunities to make choices. South Med J 2011; 104: 779–780.
 
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7. Murray K. Why doctors die differently. Wall Street Journal. http://online.wsj.com/article/SB10001424052970203918304577243321242833962.html. Published February 25, 2012. Accessed March 29, 2012.