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2009: Ethical principles in relation to advance directives and personhood

Ethical issues in practice

Clear and unambiguous wishes expressed in an advance directive may help doctors to decide on a course of treatment or care. However, a problem arises when alongside a valid advance directive, a patient has current wishes (regarding proposed treatment for which he/she does not have decision-making capacity) which may be more or less clearly expressed, more or less consistent and more or less in agreement with the view expressed in the advance directive. This can create a dilemma for doctors who are then put in the position of having to choose between formerly and currently expressed wishes. Opinions differ on this issue. Some people believe that an advance directive should be strictly followed irrespective of current wishes, whereas others take the stance that it should only be followed in the absence of clearly expressed current wishes. Other opinions tend to fall between these two extremes. Below, you will find a summary of some of the philosophical and ethical arguments linked to this issue.



Last Updated: Monday 18 July 2016


  • Acknowledgements

    Alzheimer Europe gratefully acknowledges the support of the German Ministry of Health for the implementation of the Dementia Ethics Network.
  • Bundesministerium für Gesundheit