Yet, many physicians do not initiate such discussions. For example, my colleagues and I surveyed family physicians about the use of the living will and discovered that family physicians had several concerns when they noted that they would not initiate conversations about its use. The greatest difficulty for physicians is initiating discourse with their patients about advance directives. We need to acknowledge this internal discomfort but move beyond it. Physicians may not want to concede that a patient will die in the future, but it is a reality that we all will die someday.
Advance directives offer a measure of control in the circumstances of one's death.
Families sometimes will feel uncomfortable about discussing the future death of a relative, but reminding them about preserving the liberty and dignity of that relative in offering an advance directive is a far greater ethical and legal duty. Although physicians do not want to talk about advance directives, their patients want them addressed. It is important to underscore that it is the duty of the physician to offer advance directives. Just as competent adult patients have a right to informed consent or refusal of medical therapies of all kinds, patients also have a right to have information on advance directives presented to them by their physicians. The recognition of the much greater ethical and legal weight that supports offering advance directives to our patients should help us deal with our own internal dissonance.