Table 2 Issues with advance directives

The patient has set up an advance directive already.

The patient now wants to change the primary care taker enlisted in the advance directive.

Capacity is in doubt and no thorough formal evaluation at the time of the writing of the advance directive is available.

The patient wants to set up an advance directive in the presence of the family.

The presence of and support for the advance directive by the family might suggest that a formal capacity evaluation is not required.