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Is It Finally Time for Physician Action and Reimbursement?

Linda Emanuel, MD, PhD

JAMA. 1995;274(6):501-503.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

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.

An Argument for Slow Ripening

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 . . . [Full Text PDF of this Article]

Author Affiliations
From the Division of Medical Ethics, Harvard Medical School, Boston, Mass.

Footnotes
Reprint requests to Division of Medical Ethics, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115 (Dr Emanuel).

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