The Portal of Geriatrics Online Education

Advance Directives

Advance Directives

Daniel Swagerty, MPH, Jerry Menikoff, MPH
AAMC/John A. Hartford Foundation
Donald W. Reynolds Foundation
POGOe Id: 
Date Posted: 
Date Reviewed/Updated for Clinical Accuracy: 

This module is intended to assist in teaching undergraduate medical students about advance health care planning; including, the various documents available to the provider for discussion and documentation of the wishes of patients and their surrogate decision makers. This module also discusses the issues of determination of decisional capacity and competency, with an approach provided to assess decision-making capacity. Additionally, students are provided information on the advance directive discussion and communicating with patients, families and surrogate decision makers.

Educational objectives: 

Attitudes - Medical students should be able to:

  1. Realize the importance of establishing the wishes of the patient prior to their loss of decisional-capacity when surrogacy would be required.
  2. Realize the importance of the role of the health care provider in providing the patient and their family a realistic and clear understanding of the patient's clinical situation and likely prognosis.
  3. Acquire an ability to effectively engage patients and families in discussion of these issues.

Knowledge - Medical students should be able to:

  1. Discuss a Living Will, including the definition, acquisition, utility, and limitations.
  2. Discuss a Health Care Treatment Directive, including the definition, acquisition, utility, and limitations.
  3. Discuss a DNR, including the definition, acquisition, utility, and limitations.
  4. Discuss a Durable Power of Attorney for Health Care, including the definition, acquisition, utility, and limitations.
  5. Recognize the cognitive and emotional qualities which contribute to the assessment of competency and decision-making capacity.
  6. Recognize the scope and importance of the legal context of advance directives.
  7. Recognize the importance of selected issues relating to advance directives.
  8. Describe how to appropriately begin the advance directive discussion.
  9. Describe the importance of communicating with families and surrogates concerning advance directives.
  10. Describe the importance of clarifying unclear statements.
  11. Describe the best approach to documenting the discussion of advance directives.

Skills - Medical students should be able to:

  1. Define the following entities and discuss how one acquires such a document: Living Will, Health Care Treatment Directive, DNR, Durable Power of Attorney for Health Care.
  2. Participate in a family "discussion" about these entities and recommend appropriate interventions for the patients presented in the case that follows and the Standardized Patient Encounter.
  3. Create a framework for how one would initiate and/or discuss such issues with real patients and families.
Other Learning Resource Type: 
Estimated time to complete: 
30 minutes
Contact Person/Corresponding Author:

Suggested Citation:
Daniel Swagerty, MD, MPH and Jerry Menikoff. Advance Directives. POGOe - Portal of Geriatrics Online Education; 2010 Available from: