The instrumental value of advance directives: lesson learned from the COVID-19 pandemic for policymaking

Open conversations between patients and healthcare professionals (HCP) are required to evaluate which treatments are reasonable for the individual case, especially towards the end of life. Advance Care Planning (ACP), which often results in drafting an Advance Directive (AD), is a useful tool to hel...

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Published in:Research in Health Services & Regions Vol. 4; no. 1; pp. 1 - 9
Main Authors: Stock, Elisabeth, Nickel, Christian H., Elger, Bernice S., Martani, Andrea
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 05.02.2025
Springer
Subjects:
Advance Care Planning
Advance Directives
COVID-19 pandemic
Health Administration
Health Promotion and Disease Prevention
Health Sciences
Health Services Research
Instrumental value
Medical Geography
Medicine
Medicine & Public Health
Original Paper
Resource allocation
Statistics for Life Sciences
Advance Care Planning
COVID-19 pandemic
Instrumental value
Advance Directives
Resource allocation
ISSN:2730-9827, 2730-9827
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Abstract Open conversations between patients and healthcare professionals (HCP) are required to evaluate which treatments are reasonable for the individual case, especially towards the end of life. Advance Care Planning (ACP), which often results in drafting an Advance Directive (AD), is a useful tool to help with decisions in these circumstances, but the rate of AD completion remains low. During the COVID-19 pandemic, ACP and AD gained popularity due to the alleged advantage that they could facilitate resource allocation, to the benefit of public health. In this article, which presents a theoretical reflection grounded in scientific evidence, we underline an even stronger ethical argument to support the implementation of AD in end-of-life care (eol-C) i.e. the instrumental value at the individual level. We show, with particular reference to lessons learned from the COVID-19 pandemic, that AD are instrumentally valuable in that they: (1) allow to thematise death; (2) ensure that overtreatment is avoided; (3) enable to better respect the wish of people to die at their preferred place; (4) help revive the “lost skill” of prognostication. We thus conclude that these arguments speak for promoting the territorially uniform implementation and accessibility of high-quality AD in care.
AbstractList Open conversations between patients and healthcare professionals (HCP) are required to evaluate which treatments are reasonable for the individual case, especially towards the end of life. Advance Care Planning (ACP), which often results in drafting an Advance Directive (AD), is a useful tool to help with decisions in these circumstances, but the rate of AD completion remains low. During the COVID-19 pandemic, ACP and AD gained popularity due to the alleged advantage that they could facilitate resource allocation, to the benefit of public health. In this article, which presents a theoretical reflection grounded in scientific evidence, we underline an even stronger ethical argument to support the implementation of AD in end-of-life care (eol-C) i.e. the instrumental value at the individual level. We show, with particular reference to lessons learned from the COVID-19 pandemic, that AD are instrumentally valuable in that they: (1) allow to thematise death; (2) ensure that overtreatment is avoided; (3) enable to better respect the wish of people to die at their preferred place; (4) help revive the "lost skill" of prognostication. We thus conclude that these arguments speak for promoting the territorially uniform implementation and accessibility of high-quality AD in care.Open conversations between patients and healthcare professionals (HCP) are required to evaluate which treatments are reasonable for the individual case, especially towards the end of life. Advance Care Planning (ACP), which often results in drafting an Advance Directive (AD), is a useful tool to help with decisions in these circumstances, but the rate of AD completion remains low. During the COVID-19 pandemic, ACP and AD gained popularity due to the alleged advantage that they could facilitate resource allocation, to the benefit of public health. In this article, which presents a theoretical reflection grounded in scientific evidence, we underline an even stronger ethical argument to support the implementation of AD in end-of-life care (eol-C) i.e. the instrumental value at the individual level. We show, with particular reference to lessons learned from the COVID-19 pandemic, that AD are instrumentally valuable in that they: (1) allow to thematise death; (2) ensure that overtreatment is avoided; (3) enable to better respect the wish of people to die at their preferred place; (4) help revive the "lost skill" of prognostication. We thus conclude that these arguments speak for promoting the territorially uniform implementation and accessibility of high-quality AD in care.
Open conversations between patients and healthcare professionals (HCP) are required to evaluate which treatments are reasonable for the individual case, especially towards the end of life. Advance Care Planning (ACP), which often results in drafting an Advance Directive (AD), is a useful tool to help with decisions in these circumstances, but the rate of AD completion remains low. During the COVID-19 pandemic, ACP and AD gained popularity due to the alleged advantage that they could facilitate resource allocation, to the benefit of public health. In this article, which presents a theoretical reflection grounded in scientific evidence, we underline an even stronger ethical argument to support the implementation of AD in end-of-life care (eol-C) i.e. the instrumental value at the individual level. We show, with particular reference to lessons learned from the COVID-19 pandemic, that AD are instrumentally valuable in that they: (1) allow to thematise death; (2) ensure that overtreatment is avoided; (3) enable to better respect the wish of people to die at their preferred place; (4) help revive the “lost skill” of prognostication. We thus conclude that these arguments speak for promoting the territorially uniform implementation and accessibility of high-quality AD in care.
Abstract Open conversations between patients and healthcare professionals (HCP) are required to evaluate which treatments are reasonable for the individual case, especially towards the end of life. Advance Care Planning (ACP), which often results in drafting an Advance Directive (AD), is a useful tool to help with decisions in these circumstances, but the rate of AD completion remains low. During the COVID-19 pandemic, ACP and AD gained popularity due to the alleged advantage that they could facilitate resource allocation, to the benefit of public health. In this article, which presents a theoretical reflection grounded in scientific evidence, we underline an even stronger ethical argument to support the implementation of AD in end-of-life care (eol-C) i.e. the instrumental value at the individual level. We show, with particular reference to lessons learned from the COVID-19 pandemic, that AD are instrumentally valuable in that they: (1) allow to thematise death; (2) ensure that overtreatment is avoided; (3) enable to better respect the wish of people to die at their preferred place; (4) help revive the “lost skill” of prognostication. We thus conclude that these arguments speak for promoting the territorially uniform implementation and accessibility of high-quality AD in care.
ArticleNumber 1
Author Martani, Andrea
Elger, Bernice S.
Stock, Elisabeth
Nickel, Christian H.
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Cites_doi 10.1093/geronb/gbab102
10.1007/s00063-020-00717-9
10.1002/ncp.10500
10.1177/1049909120963698
10.1086/JCE2021321013
10.1056/NEJMsb2005114
10.1016/j.jpainsymman.2020.09.021
10.1007/s11606-009-0952-6
10.1007/s11019-016-9744-z
10.1136/medethics-2011-100479
10.1186/s12910-020-00498-y
10.1186/s12904-022-00952-1
10.1001/jamainternmed.2016.0670
10.1057/s41599-021-00900-z
10.1097/JCMA.0000000000000459
10.1016/j.archger.2017.07.012
10.1001/jama.2020.4894
10.1186/s12904-022-01023-1
10.1080/07481187.2023.2180693
10.1136/bmj.p1865
10.1016/S0140-6736(21)02314-X
10.1787/722b927a-en
10.1136/EBM-2023-POD.27
10.1016/j.ejim.2007.09.002
10.1016/j.zefq.2023.04.008
10.1136/medethics-2012-100699
10.1136/bmjgh-2022-008854
10.1001/jamanetworkopen.2019.5033
10.1186/s12904-022-01060-w
10.1016/j.jpainsymman.2018.05.016
10.1093/geront/42.1.51
10.4414/smw.2020.20194
10.1016/S2468-2667(20)30146-8
10.1080/07481187.2020.1821262
10.1080/15265161.2020.1779855
10.1159/000319422
10.1111/bioe.12836
10.3390/healthcare11202755
10.1016/j.healthpol.2019.01.013
10.3390/jcm10112472
10.1023/A:1014422001048
10.1001/jamanetworkopen.2020.15762
10.2307/3527683
10.1001/jamainternmed.2016.0972
10.4414/smw.2020.20233
10.4414/smw.2018.14575
10.1111/jgs.16537
10.1111/jgs.16532
10.1089/pmr.2021.0013
10.1186/s12875-023-02038-0
10.1093/geront/gnad012
10.1136/esmoopen-2020-000953
10.30965/9783897859661_033
10.4414/smw.2014.14035
10.1136/bmj.c1345
10.1007/s11019-016-9688-3
10.1371/journal.pone.0122321
10.46998/IJCMCR.2021.17.000411
10.1186/s12904-020-00679-x
10.1186/s12904-015-0068-1
10.1002/9781444307818.ch26
10.3238/arztebl.2019.0653
10.2196/21385
10.1037/pag0000447
10.1001/jama.1995.03530200027032
10.15406/mojgg.2019.04.00220
10.1001/jamainternmed.2019.0302
10.1590/s1413-81232013000900025
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Issue 1
Keywords Advance Care Planning
COVID-19 pandemic
Instrumental value
Advance Directives
Resource allocation
Language English
License 2025. The Author(s).
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References 60_CR21
M Becerra (60_CR3) 2011; 57
60_CR20
EJ Emanuel (60_CR13) 2020; 382
DC Funk (60_CR28) 2020; 60
60_CR62
60_CR25
AS Janwadkar (60_CR50) 2020; 20
A Fagerlin (60_CR23) 2004; 34
JR Curtis (60_CR30) 2020; 323
60_CR29
A Gupta (60_CR65) 2021; 38
BL Block (60_CR33) 2020; 68
AF Connors (60_CR81) 1995; 274
NR Simon (60_CR32) 2021
K van Baal (60_CR68) 2020; 19
GW Leeson (60_CR75) 2019; 123
JM Thomas (60_CR83) 2019; 179
CS Hartog (60_CR64) 2020; 115
60_CR60
IC Otte (60_CR6) 2014; 144
J Kellett (60_CR85) 2008; 19
G Gunter-Hunt (60_CR22) 2002; 42
60_CR36
60_CR35
C Becker (60_CR80) 2020; 150
EP Sparrow (60_CR45) 2021; 36
JC Pereira (60_CR56) 2013; 18
F Erbguth (60_CR59) 2010
S Balasundram (60_CR76) 2023; 24
IC Otte (60_CR7) 2017; 20
G Jimenez (60_CR78) 2018; 56
S Jen (60_CR41) 2021; 76
LM Funk (60_CR74) 2022; 21
T Kühlein (60_CR1) 2023; 382
M-H Lin (60_CR44) 2021; 84
I Koné (60_CR48) 2018; 148
60_CR72
60_CR71
R Schnakenberg (60_CR70) 2022; 21
JD Portz (60_CR38) 2020; 22
60_CR42
GD Borasio (60_CR49) 2020; 150
A de Vleminck (60_CR24) 2015; 14
60_CR40
60_CR47
KM Detering (60_CR69) 2010; 340
AE Barnato (60_CR73) 2009; 24
C Becker (60_CR82) 2019; 2
VS Periyakoil (60_CR54) 2015; 10
60_CR8
TW Farrell (60_CR51) 2020; 68
C Fleischmann-Struzek (60_CR63) 2019; 116
J Hewitt (60_CR31) 2020; 5
D van der Smissen (60_CR43) 2024; 48
60_CR5
R Groenhout (60_CR66) 2023; 28
RJ Jox (60_CR10) 2012; 38
CL Auriemma (60_CR37) 2020; 3
DJ Doukas (60_CR46) 2021; 32
D Martins-Branco (60_CR9) 2020; 5
KB Dassel (60_CR39) 2021; 2
60_CR58
NL Schoenborn (60_CR79) 2016; 176
C Clavien (60_CR34) 2023; 180
T Rønnow-Rasmussen (60_CR53) 2002; 5
60_CR57
SA Hurst (60_CR2) 2013; 39
60_CR12
C Poppe (60_CR4) 2020; 21
60_CR55
60_CR18
CA McAfee (60_CR27) 2022; 46
60_CR17
AM Capron (60_CR11) 2009
60_CR16
60_CR15
B Schöne-Seifert (60_CR67) 2007
A Barrocas (60_CR14) 2020; 35
I Kermel-Schiffman (60_CR26) 2017; 73
B Driller (60_CR77) 2022; 21
MA Schonberg (60_CR84) 2016; 176
IC Otte (60_CR19) 2016; 19
L Sallnow (60_CR61) 2022; 399
H-J Ehni (60_CR52) 2021; 35
References_xml – volume: 76
  start-page: 1904
  year: 2021
  ident: 60_CR41
  publication-title: J Gerontol B Psychol Sci Soc Sci
  doi: 10.1093/geronb/gbab102
– volume: 115
  start-page: 571
  year: 2020
  ident: 60_CR64
  publication-title: Med Klin Intensivmed Notfmed
  doi: 10.1007/s00063-020-00717-9
– volume: 35
  start-page: 599
  year: 2020
  ident: 60_CR14
  publication-title: Nutr Clin Pract
  doi: 10.1002/ncp.10500
– volume: 38
  start-page: 191
  year: 2021
  ident: 60_CR65
  publication-title: Am J Hosp Palliat Care
  doi: 10.1177/1049909120963698
– volume: 32
  start-page: 13
  year: 2021
  ident: 60_CR46
  publication-title: J Clin Ethics
  doi: 10.1086/JCE2021321013
– volume: 382
  start-page: 2049
  year: 2020
  ident: 60_CR13
  publication-title: N Engl J Med
  doi: 10.1056/NEJMsb2005114
– ident: 60_CR21
– volume: 60
  start-page: e5
  year: 2020
  ident: 60_CR28
  publication-title: J Pain Symptom Manag
  doi: 10.1016/j.jpainsymman.2020.09.021
– volume: 24
  start-page: 695
  year: 2009
  ident: 60_CR73
  publication-title: J Gen Intern Med
  doi: 10.1007/s11606-009-0952-6
– volume: 20
  start-page: 249
  year: 2017
  ident: 60_CR7
  publication-title: Med Health Care Philos
  doi: 10.1007/s11019-016-9744-z
– volume: 38
  start-page: 540
  year: 2012
  ident: 60_CR10
  publication-title: J Med Ethics
  doi: 10.1136/medethics-2011-100479
– volume: 21
  start-page: 55
  year: 2020
  ident: 60_CR4
  publication-title: BMC Med Ethics
  doi: 10.1186/s12910-020-00498-y
– volume: 21
  start-page: 61
  year: 2022
  ident: 60_CR77
  publication-title: BMC Palliat Care
  doi: 10.1186/s12904-022-00952-1
– volume: 176
  start-page: 671
  year: 2016
  ident: 60_CR79
  publication-title: JAMA Intern Med
  doi: 10.1001/jamainternmed.2016.0670
– ident: 60_CR42
  doi: 10.1057/s41599-021-00900-z
– ident: 60_CR18
– volume: 84
  start-page: 197
  year: 2021
  ident: 60_CR44
  publication-title: J Chin Med Assoc
  doi: 10.1097/JCMA.0000000000000459
– volume: 73
  start-page: 133
  year: 2017
  ident: 60_CR26
  publication-title: Arch Gerontol Geriatr
  doi: 10.1016/j.archger.2017.07.012
– volume: 323
  start-page: 1771
  year: 2020
  ident: 60_CR30
  publication-title: JAMA
  doi: 10.1001/jama.2020.4894
– volume: 21
  start-page: 139
  year: 2022
  ident: 60_CR74
  publication-title: BMC Palliat Care
  doi: 10.1186/s12904-022-01023-1
– volume: 48
  start-page: 33
  year: 2024
  ident: 60_CR43
  publication-title: Death Stud
  doi: 10.1080/07481187.2023.2180693
– ident: 60_CR62
– volume: 382
  start-page: 1865
  year: 2023
  ident: 60_CR1
  publication-title: BMJ
  doi: 10.1136/bmj.p1865
– volume: 399
  start-page: 837
  year: 2022
  ident: 60_CR61
  publication-title: Lancet
  doi: 10.1016/S0140-6736(21)02314-X
– ident: 60_CR58
– ident: 60_CR5
  doi: 10.1787/722b927a-en
– ident: 60_CR20
– volume: 28
  start-page: A13
  issue: Suppl 1
  year: 2023
  ident: 60_CR66
  publication-title: BMJ Evidence-Based Med
  doi: 10.1136/EBM-2023-POD.27
– volume: 19
  start-page: 155
  year: 2008
  ident: 60_CR85
  publication-title: Eur J Intern Med
  doi: 10.1016/j.ejim.2007.09.002
– volume: 180
  start-page: 115
  year: 2023
  ident: 60_CR34
  publication-title: Z Evid Fortbild Qual Gesundhwes
  doi: 10.1016/j.zefq.2023.04.008
– ident: 60_CR72
– volume-title: Grundlagen Der Medizinethik
  year: 2007
  ident: 60_CR67
– volume: 39
  start-page: 158
  year: 2013
  ident: 60_CR2
  publication-title: J Med Ethics
  doi: 10.1136/medethics-2012-100699
– ident: 60_CR40
  doi: 10.1136/bmjgh-2022-008854
– volume: 2
  start-page: e195033
  year: 2019
  ident: 60_CR82
  publication-title: JAMA Netw Open
  doi: 10.1001/jamanetworkopen.2019.5033
– volume: 21
  start-page: 172
  year: 2022
  ident: 60_CR70
  publication-title: BMC Palliat Care
  doi: 10.1186/s12904-022-01060-w
– ident: 60_CR17
– volume: 56
  start-page: 436
  year: 2018
  ident: 60_CR78
  publication-title: J Pain Symptom Manag
  doi: 10.1016/j.jpainsymman.2018.05.016
– ident: 60_CR55
– volume: 42
  start-page: 51
  year: 2002
  ident: 60_CR22
  publication-title: Gerontologist
  doi: 10.1093/geront/42.1.51
– volume: 150
  start-page: w20194
  year: 2020
  ident: 60_CR80
  publication-title: Swiss Med Wkly
  doi: 10.4414/smw.2020.20194
– start-page: 39
  volume-title: Sterben Und Tod: Geschichte, Theorie, Ethik Ein interdisziplinäres Handbuch
  year: 2010
  ident: 60_CR59
– volume: 5
  start-page: e444
  year: 2020
  ident: 60_CR31
  publication-title: Lancet Public Health
  doi: 10.1016/S2468-2667(20)30146-8
– volume: 46
  start-page: 91
  year: 2022
  ident: 60_CR27
  publication-title: Death Stud
  doi: 10.1080/07481187.2020.1821262
– ident: 60_CR36
– volume: 20
  start-page: 202
  year: 2020
  ident: 60_CR50
  publication-title: Am J Bioeth
  doi: 10.1080/15265161.2020.1779855
– volume: 57
  start-page: 414
  year: 2011
  ident: 60_CR3
  publication-title: Gerontology
  doi: 10.1159/000319422
– volume: 35
  start-page: 125
  year: 2021
  ident: 60_CR52
  publication-title: Bioethics
  doi: 10.1111/bioe.12836
– ident: 60_CR25
  doi: 10.3390/healthcare11202755
– volume: 123
  start-page: 435
  year: 2019
  ident: 60_CR75
  publication-title: Health Policy
  doi: 10.1016/j.healthpol.2019.01.013
– year: 2021
  ident: 60_CR32
  publication-title: J Clin Med 10
  doi: 10.3390/jcm10112472
– volume: 5
  start-page: 23
  year: 2002
  ident: 60_CR53
  publication-title: Ethical Theory Moral Pract
  doi: 10.1023/A:1014422001048
– volume: 3
  start-page: e2015762
  year: 2020
  ident: 60_CR37
  publication-title: JAMA Netw Open
  doi: 10.1001/jamanetworkopen.2020.15762
– volume: 34
  start-page: 30
  year: 2004
  ident: 60_CR23
  publication-title: Hastings Cent Rep
  doi: 10.2307/3527683
– ident: 60_CR71
– volume: 176
  start-page: 678
  year: 2016
  ident: 60_CR84
  publication-title: JAMA Intern Med
  doi: 10.1001/jamainternmed.2016.0972
– volume: 150
  start-page: w20233
  year: 2020
  ident: 60_CR49
  publication-title: Swiss Med Wkly
  doi: 10.4414/smw.2020.20233
– volume: 148
  start-page: w14575
  year: 2018
  ident: 60_CR48
  publication-title: Swiss Med Wkly
  doi: 10.4414/smw.2018.14575
– volume: 68
  start-page: 1136
  year: 2020
  ident: 60_CR51
  publication-title: J Am Geriatr Soc
  doi: 10.1111/jgs.16537
– volume: 68
  start-page: 1395
  year: 2020
  ident: 60_CR33
  publication-title: J Am Geriatr Soc
  doi: 10.1111/jgs.16532
– ident: 60_CR16
– ident: 60_CR12
– ident: 60_CR35
– ident: 60_CR60
– volume: 2
  start-page: 194
  year: 2021
  ident: 60_CR39
  publication-title: Palliat Med Rep
  doi: 10.1089/pmr.2021.0013
– volume: 24
  start-page: 77
  year: 2023
  ident: 60_CR76
  publication-title: BMC Prim Care
  doi: 10.1186/s12875-023-02038-0
– ident: 60_CR47
  doi: 10.1093/geront/gnad012
– volume: 5
  start-page: e000953
  year: 2020
  ident: 60_CR9
  publication-title: ESMO Open
  doi: 10.1136/esmoopen-2020-000953
– ident: 60_CR15
  doi: 10.30965/9783897859661_033
– volume: 144
  start-page: w14035
  year: 2014
  ident: 60_CR6
  publication-title: Swiss Med Wkly
  doi: 10.4414/smw.2014.14035
– ident: 60_CR29
– volume: 340
  start-page: c1345
  year: 2010
  ident: 60_CR69
  publication-title: BMJ
  doi: 10.1136/bmj.c1345
– volume: 19
  start-page: 199
  year: 2016
  ident: 60_CR19
  publication-title: Med Health Care Philos
  doi: 10.1007/s11019-016-9688-3
– volume: 10
  start-page: e0122321
  year: 2015
  ident: 60_CR54
  publication-title: PLoS ONE
  doi: 10.1371/journal.pone.0122321
– ident: 60_CR8
  doi: 10.46998/IJCMCR.2021.17.000411
– volume: 19
  start-page: 187
  year: 2020
  ident: 60_CR68
  publication-title: BMC Palliat Care
  doi: 10.1186/s12904-020-00679-x
– volume: 14
  start-page: 71
  year: 2015
  ident: 60_CR24
  publication-title: BMC Palliat Care
  doi: 10.1186/s12904-015-0068-1
– start-page: 299
  volume-title: A companion to bioethics
  year: 2009
  ident: 60_CR11
  doi: 10.1002/9781444307818.ch26
– volume: 116
  start-page: 653
  year: 2019
  ident: 60_CR63
  publication-title: Dtsch Arztebl Int
  doi: 10.3238/arztebl.2019.0653
– volume: 22
  start-page: 1
  year: 2020
  ident: 60_CR38
  publication-title: J Med Internet Res
  doi: 10.2196/21385
– volume: 36
  start-page: 49
  year: 2021
  ident: 60_CR45
  publication-title: Psychol Aging
  doi: 10.1037/pag0000447
– volume: 274
  start-page: 1591
  year: 1995
  ident: 60_CR81
  publication-title: JAMA
  doi: 10.1001/jama.1995.03530200027032
– ident: 60_CR57
  doi: 10.15406/mojgg.2019.04.00220
– volume: 179
  start-page: 820
  year: 2019
  ident: 60_CR83
  publication-title: JAMA Intern Med
  doi: 10.1001/jamainternmed.2019.0302
– volume: 18
  start-page: 2699
  year: 2013
  ident: 60_CR56
  publication-title: Cien Saude Colet
  doi: 10.1590/s1413-81232013000900025
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Snippet Open conversations between patients and healthcare professionals (HCP) are required to evaluate which treatments are reasonable for the individual case,...
Abstract Open conversations between patients and healthcare professionals (HCP) are required to evaluate which treatments are reasonable for the individual...
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SubjectTerms Advance Care Planning
Advance Directives
COVID-19 pandemic
Health Administration
Health Promotion and Disease Prevention
Health Sciences
Health Services Research
Instrumental value
Medical Geography
Medicine
Medicine & Public Health
Original Paper
Resource allocation
Statistics for Life Sciences
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Title The instrumental value of advance directives: lesson learned from the COVID-19 pandemic for policymaking
URI https://link.springer.com/article/10.1007/s43999-025-00060-6
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