Advance directives (ADs) offer the opportunity for patients to express their desires regarding medical care in advance of any form of incapacitation. However, the efficacy of ADs in achieving care that aligns with patients' preferences is the subject of intense ethical debate. Current instructional AD formats may not allow for expression of the reasoning or values behind a patient's care preferences, limiting their utility and efficacy. Here, we review written AD formats and their limitations, and discuss video messages, as a supplement to written ADs, as a potential improvement. While video messages have limitations of their own, their potential use as a tool for better understanding patients' wishes and values suggests a need for further research and consideration of their application and integration into standard clinical practice.
Copyright 2022 The Journal of Clinical Ethics. All rights reserved.