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J Am Geriatr Soc. 1991 Dec;39(12):1221-8.

The health care directive: learning how to draft advance care documents.

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Division of Medical Ethics, Harvard Medical School, Boston, Massachusetts.


Despite wide popularity and numerous state statutes, living wills have been previously little used. Now the Patient Self Determination Act promises to close the gap. The medical world is obliged to move fast in an attempt to provide good advance planning to patients and to avert the possible negative outcomes of poor advance planning. A good document has the potential to stimulate good doctor-patient discussion and good planning. A model advance directive is proposed which seeks to keep the merits of the original Medical Directive yet modify it according to empirical data on its use by patients. The remodelled directive still provides an instructional section, a durable power of attorney section, a values statement section, and an organ donation section in addition to the illness scenarios section, much as in the Medical Directive. In the illness scenarios section, however, the Health Care Directive makes use of a wider range of scenarios that may be particularly relevant to the elderly or chronically ill and an intervention selection system that includes statements about goals of treatment.

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