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Do Advance Directives Direct?

Susan P Shapiro1

  • 1American Bar Foundation.

Journal of Health Politics, Policy and Law
|February 21, 2015
PubMed
Summary
This summary is machine-generated.

Advance directives, like living wills, show minimal impact on end-of-life decisions in ICUs. Their effectiveness depends on being readily available in patient charts, not just existing.

Keywords:
advance directivesintensive care unitsurrogate decision making

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Area of Science:

  • Medical Ethics
  • Health Services Research
  • Critical Care Medicine

Background:

  • Debates on advance directives (living wills, healthcare powers of attorney) persist due to limited comparative data.
  • Previous research often lacks direct comparisons of end-of-life decision-making processes and outcomes for patients with and without advance directives.

Purpose of the Study:

  • To compare end-of-life medical decision-making processes and outcomes between patients with and without advance directives.
  • To investigate the impact of advance directive accessibility on their influence.

Main Methods:

  • Ethnographic study conducted in two intensive care units (ICUs) at a large urban teaching hospital.
  • Comparison of decision-making aspects and outcomes based on advance directive status, controlling for demographics and illness severity.

Main Results:

  • Few significant differences were found between patients with and without advance directives.
  • Differences were only observed when advance directives were present in the hospital chart.
  • No significant differences were found for patients with directives held privately (at home).

Conclusions:

  • Advance directives may have limited impact unless readily accessible in the medical record.
  • Findings support literature questioning the widespread effectiveness of advance directives in their current form.
  • The accessibility of advance directives is crucial for their potential influence on care.