Analysis Ethical debate

Are advance directives legally binding or simply the starting point for discussion on patients’ best interests? Medical opinion

BMJ 2009; 339 doi: (Published 26 November 2009) Cite this as: BMJ 2009;339:b4697
  1. Kevin Mackway-Jones, professor of emergency medicine
  1. 1Manchester Royal Infirmary, Manchester M13 9WL
  1. kevin.mackway-jones{at}

    Following advance directives in emergencies throws up some complicated problems, as Stephen Bonner and colleagues found (doi:10.1136/bmj.b4667). We asked an emergency doctor, a medical defence adviser (doi:10.1136/bmj.b4693), and an ethicist (doi:10.1136/bmj.b4695) what they would do in the circumstances

    Emergency medicine, as the name suggests, is a specialty of rapid decision making, and decisions often have to be made with limited information. Emergency physicians are adept at collecting, assimilating, and assessing the available history of a patient’s condition together with relevant indicators of physical state to form a menu of possible actions. The patient’s wishes are always part of this process. Sometimes, as has been suggested here, a first assessment might seem to show that only one action (in this case immediate intubation and …

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