Monday, June 21, 2010

The Need For Discussing Living Wills Carefully

First of all, having and advanced directive (living will) is probably better than not having one. However, they are often carelessly written, and there is quite strong evidence that patients are not fully informed about what they are and what the mean. It’s particularly important that it’s not simply a “Do you want to live or die when you are in dire medical circumstances?”
Living wills' lack of specifics limits their usefulness
Patients often opt for more end-of-life care when given detailed circumstances -- at odds with responses to a general question, a new study says.
Living wills fail to capture patients' end-of-life care wishes because they do not ask about the real-life scenarios patients are likely to face as they
get close to death, according to a new study. Researchers from Thomas Jefferson University in Pennsylvania examined interview responses of 202 Philadelphia-area patients age 70 and older
for the study in the May 22 Journal of Palliative Medicine.
Patients first were asked a question used in many Pennsylvania living wills, probing whether to "withdraw life-sustaining treatment that serves only to prolong the process of dying." Patients then were queried about their desires about more specific scenarios, such as whether to use antibiotics to treat their pneumonia if they also have Alzheimer's disease. There was a 23% average correlation between the responses.
"This study points out that if you talk to people in more detail, there's more nuance to their decisions than just results from a simple question about what they want in a living will document," said Charles F. von Gunten, MD, PhD, editor-in-chief of the Journal of Palliative Medicine and provost of the Institute for Palliative Medicine at San Diego Hospice. more

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