How strictly should advance decisions be followed? The patients’ opinion

Sir – Advance treatment decisions for the case of decisional incapacity are increasingly being used by German citizens.1 The federal parliament (Bundestag) is currently debating bills on the issue, but the members of parliament struggle with the question how much legally binding force an advance decision (AD) should have on physicians.2 Although there have been many surveys among health care professionals, we could not find any survey which asked the authors of ADs themselves how much binding force they want these documents to have. As there is evidence that a terminal illness changes people’s attitudes and may weaken advance refusals of treatment,3 we aimed to compare the terminally ill and the nonterminally ill.