Precommitment: a misguided strategy for securing death with dignity

Precommitment is a seductive concept in bioethics. It is most popular as a strategy to resolve questions about the future use of life-sustaining treatment. The living will was an early focus of the death with dignity movement and its successor, the advance treatment directive, is central to medical ethics and law. This article explains why precommitment is an inferior strategy for making end-of-life decisions. It first reviews the literature and legal rules promoting advance choice as the preferred approach to resolving treatment questions. It describes empirical findings that expose problems with the advance directive approach. Then it discusses ethical and policy objections to relying on precommitment to answer treatment questions. It concludes that precommitment is an impractical and inappropriate strategy for securing humane and dignified death.