This thesis comprises a literature review, a research paper and a critical review of the research process.

In the literature review, a meta-ethnography was conducted in order to identify and synthesise 17 studies that explored a person’s experience and understanding of advance directives in physical health care. Four themes emerged: ‘hope and fears for the family’; ‘the trust between the participant and the doctor’; ‘the communication of advance directives by health care staff’ and ‘hope and fears for the individual’s future. The findings are discussed in terms of culture and identity, affective forecasting and the notion of ‘conditional autonomy’.

The empirical paper used a grounded theory informed methodology with ten participants who were all mental health professionals with experience of making a decision to give someone ECT or not. The ten participants were interviewed in order to develop a model that explained how this process occurred in clinical practice.
The critical review discusses my own epistemological position in relation to the research process and how it influenced my choice of methodology. The limitations of the research will then be reviewed specifically focusing on the challenges of involving expert by experience consultants (EbE) and recruiting service users and family to the research. The paper is concluded by linking the two research papers together by discussing the role of advance directives in ECT.