The disutility of advance directives: we know the problems, but are there solutions?

Advance directives (ADs) are recognized in some form by the laws of every state. Despite the availability of ADs for more than twenty years, few adults have completed any type of AD document. Even when ADs are validly executed, physicians routinelyfail to honor patients' wishes. The lack of communication between physicians and patients may be the primary reason why AD completion rates remain so low. The failure to honor an AD may stem from the physician's belief that to honor a directive would not be in the patient's best interest. The adoption and enforcement by all states of the Uniform Health-Care Decisions Act, recognition of a physician's ethical duty to assist patients in AD formulation, and routine third-party payor reimbursement to physicians for their role in patients' advance care planning will encourage and facilitate the completion and subsequent honoring of patients' directives.