Lena Stange

Division of Medical Ethics, Department of Health Services Research, University of Oldenburg

The drafting of advance healthcare directives relies heavily on anticipations of future life stages, the progression of illnesses and, more generally, on conceptions of a good life over time. In the discussion of advance healthcare directives to date, such time-related conceptions have largely been overlooked. This presentation argues that analysing them from the perspective of the ethics of striving can help us to better understand and ethically evaluate anticipatory decision-making processes concerning future health situations. To this end, guided interviews on advance healthcare directives were used, in which 18 adults from various age groups were asked about their conceptions of a good life and dying in the context of advance healthcare planning. The perspectives gathered were analysed using Reflexive Thematic Analysis as described by Braun and Clarke, followed by a typology based on Kluge. The analysis focuses in particular on the temporal dimensions of these conceptions and their embedding within anticipated life courses. Using this typology, the study highlights the spectrum of ideas regarding the temporal course of a good life as formulated by the respondents, and relates these to their anticipations of future life phases for the purposes of advance healthcare planning. For instance, there is the conception of a good life as a coherent life plan over time, whose core values – such as self-determination or independence – should be preserved as far as possible. Anticipated phases of illness are assessed according to whether they jeopardise this continuity, which may be reflected in more restrictive advance planning. Other conceptions view a good life as a sequence of malleable life phases in which value systems change. Accordingly, future phases of life that may be restricted are anticipated as being worth living and are taken into account in advance planning as a period of life that can be shaped. Occasionally, inconsistencies also emerge between long-term value orientations and the preferences formulated within the framework of health-related advance planning. The study provides an empirically informed and ethically grounded understanding of values and life plans anchored in the life course, thereby enabling a more in-depth ethical assessment of the internal coherence and authenticity of advance healthcare directives.