Three questions should be asked

EDITOR—The paper by Diggory and Judd1 reporting the response to their questionnaire survey shows that there is an encouraging awareness of advance directives among the responding NHS trusts but very little evidence that trusts make any routine provision for recording the existence and whereabouts of an advance directive, prepared when the patient was both calm and competent.1

The time to gather this information is on admission when name, address, date of birth, religion, and preferred name, etc are being recorded. Three simple questions added to the admission form would go a long way to alerting hospital staff to a (legally binding) directive that might otherwise be overlooked:

(1) Do you have an advance directive (living will)? yes/no

(2) Where is it kept? With general practitioner? yes/no

At home? yes/no

(3) If patient was admitted unconscious, has an advance directive card been looked for and found in patient's belongings? yes/no

Asking these questions on admission rather than later might give the many patients who are currently unaware of advance directives an opportunity for a calm discussion with hospital staff. To raise the subject later—for example, when they are about to sign a consent form for treatment—would create unnecessary alarm and even confusion with a last will and testament.

Maybe national guidelines are needed

EDITOR—Perhaps the most interesting result of the survey by Diggory and Judd on advance directives was that three quarters of the NHS trusts responding to their questionnaire were in favour of national guidelines, which suggests that …