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Advance decision-making: Advance directives and proxy decision-making in France and in England (ADVANCED)
Start date: Sep 1, 2010, End date: Aug 31, 2012 PROJECT  FINISHED 

"How should one take into account a patient's wishes when he or she is no longer capable of expressing those wishes? Both France and England have recently introduced new legal frameworks aimed at answering this question. In both jurisdictions the status of advance directives has now been clarified, and, in England, a patient is also now able to appoint a health care proxy, such as a loved one, to take decisions on their behalf should they become incompetent. Each of these models of advance decision-making presents ethical challenges, not least in the potential conflicts that can arise between the patient's perceived wishes and the health professional’s duty to treat. Indeed, although medical attitudes to patient autonomy appear to differ between France and England, take-up of the new laws in both countries has been similarly small. This project will seek to explore the similarities and differences between the different models of advance decision-making and between the different ways they are theorised and actualised in these two countries. The project will further aim to identify common themes and attempt to shape a common understanding about advance decision-making for deployment in debates in the French and English contexts (and beyond). Research into these concepts and the associated practices is essential, given not only considerable theoretical interest in the concept of patient autonomy, but also policy developments internationally on the care of the incompetent patient, particularly at the end of life. This project will therefore encompass a conceptual and normative exploration of advance decision-making, and an empirical study of the views and practices of doctors in both France and England."

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