Limitations of listing specific medical interventions in advance directives

Recent events, including the Cruzan decision and the passage of the Patient Self-Determination Act, have renewed interest in the strengths and limitations of various types of advance directives. In one well-known approach, the competent person indicates preferences for or against a series of specific medical interventions that might be considered if the person loses decision-making capacity. However, such lists of interventions may shift attention away from overall treatment goals or may prescribe inappropriate medical care. Moreover, listing specific interventions in advance does not necessarily enhance self-determination or reduce uncertainty in decision making. (JAMA. 1991;266:825-828)