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Advance Directives: Rarely Easy, Always Important
| April 10, 2012
'Without advance directives, even a loving child may be ignorant of her parent's wishes,' author Susan Jacoby writes in a recent New York Times editorial, Taking Responsibility for Death. ' When Susan's own mother died, many years after writing her directives, Susan said, 'It was an immense comfort to me, at a terrible time, to have no doubts about what she wanted."
Unfortunately, implementing an advance directive can sometimes be more complicated than writing one. ' Amy Berman, Program Officer for the John A. Hartford Foundation, writes about her uncle being pressured to rescind his 'do not resuscitate' order (DNR) in order to undergo surgery to repair a broken hip.' Her blog post, Can Someone Override Your Advance Directive?, raises a number of questions: Did the doctor pressure her uncle because 'DNRs can hurt the physician's quality metrics'? ' Or was it because, as a commenter points out, 'putting a patient under anesthesia for a procedure constitutes a positive intrusion into their own life support mechanisms'? And lastly, is it possible to write a directive that will account for every contingency?
Even in more clear-cut situations, implementing an advance directive is not always easy.' At the GeriPal blog, Dr. Dan Matlock writes about Being Accused of Murder in spite of a patient's very clear-cut advance directive: 'The patient had suffered a devastating stroke. Her advance directive (notarized no less) stated that she did not want any artificial means of life support, specifically mentioning artificial nutrition or hydration.' Yet in order to convince the primary care team that the artificial hydration the patient had been given should be discontinued, Dr. Matlock had to call the patient's sister, who had been granted medical power of attorney. Remarkably, the patient's primary care doctor accused Dr. Matlock of murder, an experience that is not uncommon among palliative care specialists, according to a study Dr. Matlock cites.
All three essays show that carrying out an advance directive can be tricky and appointing a health care proxy or medical power of attorney with whom you've had a frank discussion about your end-of-life wishes can help. ' For more information, check out the Prepared Patient'® feature article Advance Directives: Caring for You and Your Family.
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