The Problem With Advanced Directives

Advanced directives, are documents used to communicate the type of care a person wishes to have at the end of life once the individual is too ill or injured to speak directly. They are intended to guide treatment and often identify what kinds of treatment someone wants or does not want. The reason is to alleviate worries about suffering at the end of life by being put through often pointless and unpleasant medical care.

Unfortunately, there are many issues with directives. The greatest challenge is communicating to caregivers, including emergency room staff, that an advanced directive even exists. Another challenge is that household members might not follow directives out of hopes that the medical treatment will work. Advanced directives are not legally binding, consequently, caregivers usually defer to the family members’ wishes.

First -responders are taught to ignore advanced directives and attempt resuscitation in most scenarios for both practical and legal reasons. An ambulance crew can't delay care waiting to see if an advance directive is in place. These responders are trained to continue unless a Polst Do-Not-Resuscitate form has been recorded. The Polst form is submitted through the medical system and is different from an advance directive.

Advanced Directives as a medical-legal document also have many obstacles. The document tends to use vague language that doesn’t really provide guidance to doctors. For instance, a doctor and an individual may have different concepts of the phrase “terminal”. Physicians confronted with the option of trying to interpret a vague directive and the possibility of a lawsuit filed by angry relatives, usually simply disregard the advance directive.

Research revealed in 2014 in the Journal of the American Geriatrics Society, noted that 47% of elderly patients had advanced directives in 2000, by 2010 that amount had increased to 72%. Regardless of the escalation in advance directive use, no change in the amount or the kind of healthcare given at the end of life was observed.

Is there a better way for people to communicate their end of life wishes? Tell us what you think!