Abstract
The AMA Council on Ethical and Judicial Affairs recommends that physicians discuss advance directives with their patients and the patients' proxies. It is difficult, if not impossible, to dispute the wisdom of these recommendations. The Council could have gone further, however, by recognizing the difficulties physicians will encounter in trying to implement its proposal in a managed health care system. There is an undeniable need for caregiver participation in end-of-life planning, but today's health care system must recognize and support implementation of the Council's recommendations to make that possible. More explicit recognition of this fact on the part of the Council would have helped physicians attempt to comply with its recommendations.
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