Living Wills in the End-of-Life Care in General Practice

Background: The wishes of incompetent patients concerning their medical treatment could often not be taken into account, due to the low incidence of living wills or to them not being informative enough. These problems could be solved by discussions between physicians and patients in the process of completing living wills. In this study, we investigated the importance of living wills in general practice and how discussions between General Practitioners (GPs) and patients take place. Participants and methods: In a qualitative design, we conducted semi-structured interviews with 13 GPs. The transcripts were analysed following Grounded Theory techniques. Results: According to the GPs, living wills are an important source of information for in-patient medical decisions, but they considered this function marginal in their own practice. If patients are seriously ill, the GPs strived towards the completion of a living will particularly to protect them from receiving life-sustaining treatment in hospital which they did notwant. Moreover, they feared to be prosecuted for withdrawing or withholding treatments without a living will. They organised the actual discussions to save time and did not initiate them until they were sure that the patient was prepared to cope with end-of-life issues. Conclusions: The engagement of the GPs for advance care planning has to be judged positive. It seems to be desirable to initiate the discussions about living wills earlier und to generate more actively the patients' readiness for precautionary measures.