Monday, April 26, 2010

Whose job is it to discuss advance directives?

Whose job is it to discuss Advance Directives?

When I think about this subject and obviously I think about it a lot. I equate it with it is every ones job but no one knows how to do it.

In nursing school it is brushed upon. In medical school it is not talked about. In Law school they often have internships on it? But as much as I feel my attorney colleagues have their place I don't feel explaining medical procedures should be done by someone who is not medical.

So Who Should be discussing Advance Directives?

The Attorney: Often attorneys draft health care proxies and living wills along with a Last Will and Testament. These health care proxies and living wills often get locked in the safe with the Last Will and Testament and don't get looked at again. I have heard rumor of 30 page documents in legal terminology. In speaking with one attorney who is sympathetic to my cause he mentions as the only legal document that an attorney drafts and unleashes on the general population.

The Doctor: Recently laws have been enacted to assist physicians in having these conversations. Health care costs are increasing, overhead is increasing. This is not often on the physician's radar as a high priority. Many times these discussions happen with family members of the patient not the patient in an emergent time.
The U.S. Agency for Healthcare Research and Quality (, in a 2003 article, “Advance Care Planning: Preferences for Care at the End of Life,” found:

* Only 12 percent of the patients with an advance directive received input from the physician in the development
* Between 65 and 75 percent of physicians whose patients had advance directives were not aware they existed.

The physician is suppose to follow this but doesn't even know the patient has this document in place and the physician did not have any input on it.

The Nurse: This group of health care professionals are an ideal group to assist the community in making educated health care decisions. Nurses are educators and advocates,

More Americans Discussing – and Planning – End-of-Life Treatment. The Pew Research Center, January 2006.

*42% of Americans have had a friend or relative suffer from a terminal illness or coma in the last five years and for a majority of these people and 23% of the general public, the issue of withholding life sustaining treatment came up.
*One of the most striking changes between 1990 and 2005 is the growth in the number of people who say they have a living will – up 17 points, from 12% in 1990 to 29% now

29% is not enough.

I have read other reports that say the percentage of advance directives has increased.

It does not matter how much the research says that advance directives have increased. The problem is if your loved one has not discussed these issues and you are charged with making their wishes known to the health care practitioners that are charged with caring for someone you love.

How can you make these complicated health care decisions if you don't know what your loved ones would want?

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