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Advance Directives Are Usually Followed

Most People With Living Wills or Health Care Proxies Have Their Treatment Wishes Honored
By
WebMD Health News
Reviewed by Laura J. Martin, MD

March 31, 2010 -- Advance directives, which describe the medical care you want to have if you're incapacitated, are honored most of the time, a study shows.

''If you take time out to put together a living will or durable power of attorney for health care, most often you get your wishes," says study researcher Maria J. Silveira, MD, MPH, a  clinician scientist at the Ann Arbor VA Medical Center and an assistant professor of medicine, University of Michigan School of Medicine, Ann Arbor.

The study is published in The New England Journal of Medicine.

The results of her new study, Silveira concludes, support the continued use of advance directives.

There are two types of advance directives: a living will or a medical power of attorney, also known as a health care proxy. A living will informs your doctor and your family about the type of treatment you'd want to receive if you are unable to make your own medical decisions. A medical power of attorney assigns a person -- called a health care proxy -- to make the decisions for you.

Advance directives became more common after the passage of the Patient Self-Determination Act in the U.S. 20 years ago, but debate about the usefulness of the documents has been ongoing for several years, Silveira tells WebMD.

During the recent health care reform debate, a proposal to pay back health care providers for advance directives planning discussions through Medicare sparked controversy, raising concern that these advance directives would result in denial of necessary care, Silveira says.

Honoring Advance Directives

Silveira and her colleagues used data from the Health and Retirement study, a nationally representative group of U.S. adults age 51 and older, taken every two years.

They looked just at people 60 and older who had died between 2000 and 2006, asking a family member or other informed person to answer questions about circumstances and decisions after the participant's death, usually within 24 months of the death.

Among the 3,746 people 60 and above who died, 42.5% had to make treatment choices and 70.3% of those did not have the ability to decide for themselves.

One surprise: 67.6% of those who lacked decision-making ability had advance directives -- either a living will, health care proxy, or both.

So were their wishes followed?

''What we found was, the agreement depended on what the patient wanted," Silveira tells WebMD.  "Almost everyone who wanted comfort care got it." If they asked for limited care -- not the most aggressive but beyond comfort care -- 83.2% got it, she found.

Only half of the 10 people who requested ''all care possible,'' the most aggressive approach, got it. But Silveira says that was sometimes because ''all care possible'' couldn't be given.

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