"Why should I question a patient's wish?" A comparative study on physicians' perspectives on their duties to respect advance directives

Abstract

This article explores factors that impede the implementation of advance directives to refuse treatment (ADs) in three European countries: England, Germany and France. Taking into account socio-cultural and legal aspects, the article shows the extent, to which the law can, and does, influence physicians' decisions to implement ADs. The findings presented are based on qualitative interviews exploring physicians' sense of duty to respect ADs and the reasons given for failing to implement the law. It will be argued that this depends on: 1) how strictly the legal status of ADs is defined, and 2) whether the law actually addresses the reasons why physicians may hesitate to implement ADs (e.g. uncertainty about validity, importance of patient preferences). The article emphasises the importance of doctor-patient communication and shows how the implementation of ADs could be improved by making discussions about treatment preferences a legal requirement.