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Why Advance Directives Don't Work, and What to Do about It

Published by Chapster on 2002/12/23 (2982 reads)
"The SUPPORT study done in 1995 showed that fully 80 percent of us die without the capacity to make decisions for ourselves." Evidence indicates that the hoped for outcome of advance directives - that people would write down their preferences for end-of-life-care simply isn't happening. The following article, dealing with advance directives, is a script from an interview we did in 2002 at the KEOM 88.5FM, Mesquite Schools Radio studios.

Q: So, Mike, what are we talking about today?

A: Today, I thought we'd chat a little bit more about a subject we covered in the distant past but bears repeating. It is the subject of Advance Directives. We'll probably try to cover this a little more in the future, as well. When we talk about Advance Directives, we are talking about the process of planning what kind of interventions we would and WOULD NOT want to have in the event that we were injured or ill to such an extent that we were unable to effectively and clearly make our wishes known. We often assume, wrongly I might add, that we will be able to make our wishes known until the very end.

Q: So, we generally aren't able to make our wishes known near the end of life?

A: No. The SUPPORT study done in 1995 showed that fully 80 percent of us die without the capacity to make decisions for ourselves. Death avoidance is just so deeply built into our psyche that we cannot envision ourselves ever coming to a time where we will be, say, unable to even be aware of our surroundings.

Q: So, what kinds of options do people have to prepare for those kinds of circumstances?

A: Basically, since the late 80's and the nineties, we have had two documents, both of which we have talked about before here: the Living Will, now called a Directive to Physicians, and the Durable Power of Attorney for Healthcare Decisions. Unfortunately, it has been learned recently that even these are not really adequate to protect your choices.

Q: So, Mike, I presume you do have a way for our listeners to address this concern?

A: You're right. What research has shown is that the best way to insure that your wishes are honored is to discuss them with your entire family and, then, put them on paper using the two documents I just mentioned. What has been discovered from the study mentioned above is that two-thirds of the time, where patients have an advance directive on the chart, physicians never even read it. Unless the family is actively advocating for the patient and are on the same page regarding the patient's wishes, there is very little chance that our Advance Directives will be honored.

Q: So what is important then is both the involvement of family and the use of the legal documents?

A: Exactly, that is what has been learned in recent years. Interestingly, families only guess correctly what their loved one would want about fifty percent of the time, without this kind of open discussion and the documents.

Q: How specific do these discussions have to be?

A: They should be very specific. It is not enough to say, "I don't want to be hooked up to a lot of tubes." That kind of statement is meaningless, legally or practically. For instance, it doesn't even describe what kind of tubes are being referred to. Really, what needs to be discussed fits into the following categories: Under what situations would you want or not want CPR and other resuscitation measures taken, when would you want or not want artificial feeding and hydration, when and under what circumstances you would want aggressive treatment and when you would just want to have your symptoms controlled, and finally, what level of comfort you want. These things should all be specified.

Q: That covers a lot of ground.

A: Indeed. The thing is that health care, in many ways, is so much more complex now. A single illness often destroys many years of life savings. So, what I thought we'd do is cover some of the options that are available in the next couple of months, and hopefully, demystify the topic a little more, make it a little more user-friendly.

Q: So, Mike, in the meantime, where can our listeners get more information on these topics?

A: They can visit our site, www.elderhope.com. Also, there is a section of our site with links that has a lot of helpful information.

References:
http://www2.edc.org/lastacts/readmore.asp

http://www.ama-assn.org/sci-pubs/sci-news/1995/snr1122.htm#oc4e15

Tags: ethics   living   dying   directive   advance   will  

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