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Advance Directives Are Usually Followed

Most People With Living Wills or Health Care Proxies Have Their Treatment Wishes Honored

Honoring Advance Directives continued...

One example: A person with very low blood pressure who wanted dialysis if needed would not be given it, she says, as the dialysis would lower their pressure more and perhaps hasten death.

The health care proxy wish was nearly always carried out, she found. ''Thirty percent of the [3,746] older adults needed surrogate decisions," she says. "When they appointed a durable power of attorney for health care, 92% of the time they got the decision maker they chose.''

Silveira's bottom line? "No one is claiming these things are perfect,'' she says of advance directives. "But they are better than nothing. They are meant to make a difficult situation a little bit less so for the family. Without them, what else do we have?"

Advance Directives: Second Opinion

Not everyone agrees entirely with the study's conclusions. Muriel Gillick, MD, a clinical professor of population medicine at Harvard Medical School and a practicing physician, wrote an editorial to accompany the study. She finds a health care proxy helpful but criticizes the living will as ''mostly useless.''

Part of the problem, she says, is that the documents spell out preferences for specific interventions, but that a patient can't really make informed choices until he or she knows the pros and cons of the treatments, and that a patient's preference may change once the condition is real, not theoretical.

The study method could have affected the results. "The study relies on the memories of friends or family members, an average of a year after the person's death. One has to question the accuracy in terms of the details of those memories," Gillick tells WebMD.

Both the passage of time and the usually heightened emotions at a time of crisis could have affected the memories, she says.

Finding a health care surrogate in advance, however, is a good idea, Gillick says. "Talking to a health care proxy is helpful."

The new study results, she says, demonstrate that talking about the goals of medical care at a time of crisis or end of life seems to becoming more acceptable to Americans.

Advance care planning should include a conversation with your health care provider, she says. It should include a process of clarifying the patient's current health status, talking about goals, and then designating a health care proxy to work with the doctor in interpreting and carrying out the goals when needed.

One program that uses this approach, she says, is called the Physician Orders for Life-Sustaining Treatment, adopted in a dozen states and being introduced in others.


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