Medical, ethical, and legal guidelines recommend that decisions about life-sustaining treatment be made jointly by physicians and competent, informed patients.1-4 Many patients, however, are incompetent when such decisions must be made.5 For these patients, it is recommended that clinicians follow wishes that the patient had previously expressed when competent.1-4 Although such advance directives respect patient autonomy, several reservations about them have been raised.2,4,6 Patients may not want to discuss life-sustaining treatment in advance, may not deliberate about their preferences, or may change their minds as their disease worsens and decisions become real rather than hypothetical. Physicians may fear that such discussions will cause the patient to become anxious or depressed. Refusal of treatment may be due to reversible medical or psychosocial problems.7 To address these issues, we administered questionnaires to outpatients who might require decisions about life-sustaining treatment.
PATIENTS AND METHODS
The site of the