Advance directives Doctors may not comply By Helen Fields


Advance directives
Doctors may not comply
By Helen Fields

As people get closer to dying, deciding how they would want their disease to be treated can become more difficult. Many patients, anticipating these problems, draw up advance directives to tell their doctors what kind of care they want in case they become unable to make decisions. Two doctors in Loma Linda, Calif., sent a survey to doctors asking if they would comply with several hypothetical advance directives.

What the researchers wanted to know: Do physicians comply with advance directives?

What they did: The researchers mailed a survey with six hypothetical cases to 250 doctors in internal medicine at three teaching hospitals in California; 117 were returned, 77 from faculty and 40 from residents. In each case, the advance directive was contradicted by the situation—either the family wanted something else, or the doctor thought the patient would be better off with treatments other than what they asked for. For example, in one case, a woman with diabetes on dialysis has had a stroke and can't speak or understand speech, and the neurologist thinks she's unlikely to recover. Her advance directive asked that she receive full treatment no matter what the prognosis and names her husband to make decisions for her—but her husband has asked that dialysis be stopped. The doctors had to answer whether they would stop dialysis or continue it.

What they found: Almost two thirds of the time, the doctors said they would go against the advance directive. Faculty and residents were equally likely to go against a patient's documented wishes.

What the study means to you: Your advance directive may not accomplish what you think it will.

Caveats: Well, obviously, since the survey was based on hypothetical situations, this may not be how physicians actually work—and most cases probably aren't as sticky as these, which were drawn up to contain conflict. Also, the sample size was quite small and localized, and fewer than half of the surveys were returned.

Find out more: explains advance directives, do-not-resuscitate orders, living wills, and durable powers of attorney.

The University of Washington medical school has a Web page for medical students on the ethics of dealing with advance directives.

Read the article: Hardin, S.B. and Y.A. Yusufaly. "Difficult End-of-Life Treatment Decisions." Archives of Internal Medicine. July 26, 2004, Vol. 164, pp. 1531–1533.




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