This study by Margaret Brown, Justin Beilby and Eric Gargett explores the issues that South Australian general practitioners must consider when introducing advance directives to their patients. There is a lack of information available to assist people to make complex decisions about their dying.

General practitioners could assist older patients to understand their choices and how advance directives might enable them to maintain some control, autonomy and dignity as they face death.

In April 1996 the South Australian Government released a policy document Aging: a ten-year plan for South Australia. This document emphasised the right and expectation of full citizenship for all individuals in this state from birth until death. Maintaining a sense of autonomy and dignity as one ages and faces death is integral to the nature of citizenship. More research is required to understand how this sense of autonomy and dignity can be maintained as we age. General practitioners could play an important role by introducing advance directives to their elderly patients in order to assist them and their families to face the future calmly and reassure them that control need not be lost during an serious illness or as they face death.

This study explores the issues which South Australian general practitioners must consider when introducing advance directives to their patients. An advance directive is a set of instructions given in advance by an individual about future health care decisions. It is based on the premise that if people know that their autonomy will be respected and that they can have some say about their treatment decisions when they are dying, they will be able to confront their death with less anxiety.

This is particularly relevant for the increasing number of elderly people in this state who may not want their death to be protracted unnecessarily by technological intervention. It is not death that most people fear but dying. To know that one’s autonomy will be respected, if at all possible, should reduce the fear and stress associated with dying. The rationale for this argument comes from a large body of literature which demonstrates that human beings cope better with stress when they feel they have control (Shultz and Schlarb 1986).

Completing an advance directive involves a series of complex decisions and challenges individuals to think about their dying. Currently there is a lack of information to assist individuals in making these decisions. General practitioners could assist older people in understanding their choices and how advance directives might assist them in maintaining some sense of control.