What Do Patients Express as Their Preferences in Advance Directives?

Abstract

The overwhelming desire expressed by the patients in the ADs was not to have their lives prolonged if their medical condition were such that treatment would merely delay death. Only a minuscule number of patients, less than 0.7%, wanted everything done to prolong life regardless of the chance for improvement or the cost. Because such a small percentage of patients have ADs, it is recommended that each hospital appoint a committee on ADs to do everything possible to encourage patients to execute an AD. A second mission of this committee would be to do everything possible to encourage physicians to pay close attention to their patients' wishes for medical care at the end of life.

Outcome of Adult Cardiopulmonary Resuscitations at a Tertiary Referral Center Including Results of "Limited" Resuscitations

“…2 Patients, with the guidance of physicians and/or social workers, can limit resuscitative measures in the event of a sudden arrest or critical worsening from a previously stable physical condition. This has resulted in a "limited code" phenomenon.…”

Emergency clinicians' attitudes and decisions in patient scenarios involving advance directives

“…One study showed that the most recurring directive request was ‘not for CPR’ 6. Being free of pain and not prolonging life in the setting of an incurable illness, injury or permanent change in quality of life are also common wishes 7 8. Although interventions have been implemented to increase prevalence and, theoretically, compliance with patients' wishes, such as the ‘Respecting Patient Choices©’ program in some hospitals, the existence of an AD does not guarantee that its conditions will be met 4…”

Ethical Considerations in Executing and Implementing Advance Directives

“…Central to this article are a number of unexamined assumptions. Several of these seem worth examining: (1) prior to losing their ability to make decisions, patients should be able to express their wishes about treatment and express them in documents that in the future might be binding on physicians and other health care providers; (2) when it comes to treatment decisions about theoretical situations not actually faced by patients at the time these documents are executed, patients' wishes should remain stable over time and not be changed at the time the situation is actually faced;…”