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Table 4 Sub-categories of specific congruencies and incongruities

From: To what extent are the wishes of a signatory reflected in their advance directive: a qualitative analysis

Categories

Examples of incongruities

Congruence/Incongruity

Statements in interviews

Findings in advance directives (AD)

Up-to-datedness

“After completion, I regularly signed it to reconfirm its contents.” (24S)

No more than one signature, dating from the day of completion in 04/2004.

Place of death

“I want to die in a hospice or a palliative care unit.” (12D)

The preferred place of death, as stated in her AD, is her home.

Values

“I described the values that are important for me when it comes to dying and that they are based on my faith.” (47D)

Neither faith nor faith-based values were mentioned.

Requested/Wanted measures

“I want efficient pain control, no matter what happens.” (15 L)

The participant refuses any kind of measure or treatment.

Rejected measures

“I would not want to live without legs or with paraplegia. For these situations, I refuse any further treatment.” (2B)

AD addresses permanent unconsciousness, probable permanent brain damage, permanent failure of vital body functions but neither amputation nor paraplegia.

Time limits

“I am very clear about how long I would accept certain measures and have explained this in my AD. For example, I would accept a percutaneous feeding tube for no longer than 3 three weeks and then only if I will fully recover.” (14 W)

A time limit for a percutaneous feeding tube is not mentioned. AD states different time limits on different pages for resuscitation (e.g. no resuscitation after 7 min/3 min of cardiac arrest) and for discontinuation of certain measures in case of unconsciousness/coma (after a maximum of 3 months/3 weeks).

Healthcare proxy and endurable power of attorney

“My two sons are my proxies. They live nearby and know very well what my preferences are.” (21S)

Not her sons but her husband is named in the document. He had died three years ago.

Context of use of the AD (dying process, certain illness, emergency)

“If I am no longer able to speak, eat or swallow.” (16H)

The document is only valid for the dying process.