Communication through advance directives.

There are two kinds of justifications for advance directives. The first is that they extend patient autonomy into the future, allowing individuals to control or at least influence their care after they have lost the capacity to make decisions. The second is that they help physicians and family members make emotionally stressful decisions in difficult circumstances. Whether directives are written or unwritten is of secondary importance. The primary concern is that they are based on an adequate understanding of medical options. Two cases illustrate the relative importance of these features of advance directives.