THREE ARTICLES in the current issue of the Archives analyze the willingness of physicians to talk to their patients about end-of-life concerns. One of these articles1 also studies the patient's desire for such a conversation. Not surprisingly, many physicians continue to be unwilling to talk to their patients about such matters despite the fact that most patients (as well as the physicians themselves when they see themselves as patients) would want to participate in such discussions.1-3 In the study by Markson et al,3 an educational intervention of both didactic material and practical experience is employed to facilitate the use of advance directives (ADs) by physicians.
An implicit assumption throughout these articles is that the use of ADs by patients is not only ethically acceptable but is, indeed, a good thing. Previous literature gives ample warrant for this assumption. Those of us who have quibbled with ADs in
Loewy EH, Carlson RW. Talking, Advance Directives, and Medical Practice. Arch Intern Med. 1994;154(20):2265–2267. doi:10.1001/archinte.1994.00420200011001