Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

© Ruth Horn, 2016. This article explores factors that impede the implementation of advance directives to refuse treatment (ADs) in three European countries: England, Germany and France. Taking into account socio-cultural and legal aspects, the article shows the extent, to which the law can, and does, influence physicians' decisions to implement ADs. The findings presented are based on qualitative interviews exploring physicians' sense of duty to respect ADs and the reasons given for failing to implement the law. It will be argued that this depends on: 1) how strictly the legal status of ADs is defined, and 2) whether the law actually addresses the reasons why physicians may hesitate to implement ADs (e.g. uncertainty about validity, importance of patient preferences). The article emphasises the importance of doctor-patient communication and shows how the implementation of ADs could be improved by making discussions about treatment preferences a legal requirement.

Original publication




Journal article


European Journal of Health Law

Publication Date





523 - 540