In fact, most of the time, advance medical directives are difficult to apply, given that when they are prepared the person is not necessarily given guidance. The context is then hard to apply. When the requests are made, we often hear much more what the family is telling us.
A study done in Quebec by a group led by Ariane Plaisance shows that people don't know what medical assistance in dying or advance medical directives really are. When they are asked whether they want medical assistance in dying, they understand that we are asking them whether they want good palliative care.