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Advance care directives are not always helpful

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Universal advance care directives may not alleviate the current difficulties surrounding end-of-life discussions

There is an increasing call within this country for patients to express their desired level of care in the event of medical deterioration ahead of time.1 While this has previously been pertinent in the case of patients with chronic irreversible illness, there is an additional argument and evidence that the practice should be more widespread among elderly Australians in general.2 It has even recently been discussed at the Festival of Dangerous Ideas in Sydney, where the cardiologist David Celermajer suggested that all citizens over the age of 73 years should have a clear advance care directive (ACD) in place or lose their Medicare card.3

ACDs are documents that state the level of care that patients would want if they were to become significantly unwell, in case their ability to communicate this or their capacity was lost.1 Clearly there are potential benefits to patients possessing ACDs. When somebody approaches the end of his or her life, one of the most difficult discussions in medical practice is always that which involves the limitation of care. This may occur directly with the patient in question or, when this is not possible, with the patient’s next of kin or family. There is little…