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Taking Advance Directives Seriously: Prospective Autonomy and Decisions Near the End of Life

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In the quarter century since the landmark Karen Ann Quinlan case, an ethical, legal, and societal consensus supporting patients' rights to refuse life-sustaining treatment has become a cornerstone of bioethics. Patients now legally can write advance directives to govern their treatment decisions at a time of future incapacity, yet in clinical practice their wishes often are ignored.

Examining the tension between incompetent patients' prior wishes and their current best interests as well as o...