• N W Paul and A Fischer.
• Institut für Geschichte, Theorie und Ethik der Medizin der Johannes Gutenberg-Universität Mainz, Mainz. npaul@uni-mainz.de
• Dtsch. Med. Wochenschr. 2008 Feb 1;133(5):175-9.

BackgroundKnowledge and values prevalent with regard to advanced directive in the general German population have so far not been adequately taken into account as a topic of regulatory initiatives. This leads to unnecessary uncertainty about actual decision-making concerning therapeutic measures.Methods95 randomly chosen persons were included in a differentiated, online-supported survey consisting of multiple-choice questions as well as open interview questions, both question types addressing knowledge and values prevalent in our populations concerning advanced health care directives. Multiple choice questions were statistically correlated with open answers addressing the same content and free answers were transcribed, coded and statistically analysed. Additionally data on gender, age, and education were recorded and correlated with the other results.ResultsThere was a significant correlation of answers with education and age. But the most striking result was the high level of uncertainty in the answers with respect to medical aspects of advance directives. Furthermore, there was a significant interest in the legal status of such directives. It was also clear that there were hopes and fears, mentioned in connection with the advance directive: they were most often based on a misunderstanding oft the purpose and range of advanced directives. This was true als of well-educated persons.ConclusionIndispensable preconditions for formulating advance directives is that they can be fully applied in a clinical context an should thoroughly reflect personal values as well as realistic and detailed knowledge of medical decisions at the end of a person's life. Counseling of patients who wish to formulate an advance directive should therefore be primarily a task for physicians and not of lawyers.

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