Advance Decisions: issues of autonomy, identity and efficacy

The purpose of this paper is to introduce Advance Decisions, address low uptake and examine fundamental issues that can inform the development of policy and practice in this area.

This paper discusses findings from a research project with the charity Compassion in Dying (analysing calls to its telephone helpline) and practical experience of working with the charity Advance Decisions Assistance (helping people write Advance Decisions and training healthcare professionals).

Older people themselves identify the issues of autonomy, identity and efficacy as key challenges in writing Advance Decisions and having them respected.

This paper shows how addressing the “real world” challenges of advance decision making can inform policy and practice.