Advance Directives: Patient Beware

Most people think advance health care directives and living wills are understandable, ironclad and followed to the letter.

Many believe the purpose is simply to help health care providers carry out a patient’s wishes of how they want to be treated if they become unable to speak for themselves.

In reality, such documents are often confusing, unclear, or outright ignored.

Sadly, they can provide a vehicle that neatly fits in with the growing culture of death, which increasingly believes that people have a right—and in some cases a duty—to die.

Thanks to Obamacare and our secularized culture, there are those calling for the rationing of health care and even denying some routine treatments for patients over a certain age.

The result is that living wills, or advance directives, are often interpreted as meaning the patient would rather die than live with a serious disability.

And while the idea of advance directives may be well-intentioned, they often fall far short of the mark. 

There are hundreds of studies documenting serious problems with the design and implementation of advance directives.

For example, GRTL recently received a complaint that a hospital denied a patient with an advance directive nutrition and hydration, even though his family asked that they be provided.

The concept of a living will was developed in 1967 by the Euthanasia Society of America and the Euthanasia Education Council. It was designed as a first step toward public acceptance of euthanasia.

In 1976, California was the first state to legalize living wills by adopting the California Natural Death Act.

Then in 1991, the U.S. Congress passed The Patient Self-Determination Act which requires most health care organizations to inform patients of their right to make advance directives concerning their medical treatment.

 The following are a few facts about advance directives and living wills:

  • Less than one-third of Americans have one.
  • Only half of terminally ill patients have directives.
  • Physicians often lack access to them.
  • Families are often unaware if the patient has a directive.
  • 25% of patients receive treatment inconsistent with their wishes.
  • 29% of patients change their minds about life-sustaining treatment over time.
  • 30% of surrogates incorrectly interpret their loved ones’ written instructions.
  • 64% of dying patients’ living wills do not cover the clinical realities they face.
  • 40% of patients with disorders of consciousness are misdiagnosed.
  • Along with 24 other states, Georgia allows physicians or administrators to override the wishes or desires of an advanced directive.

Clearly, families facing end of life decisions for a loved one need to be better equipped to make sure their loved one's wishes are followed correctly.

Perhaps more importantly, people need to carefully consider if they should even have an advance directive.

In 2007, Georgia joined many other states and created the Georgia Advance Directive Health Care Act. The law replaces both “living wills” and “durable powers of attorney” with the Georgia Advance Directive for Health Care which allows you to legally appoint your Health Care Agent sometimes referred to as a Medical Power of Attorney.

An excellent analysis of the facts about advance directives is given in testimony by Alliance Defending Freedom attorney, Catherine Foster. (link).

Because of the various problems listed above, GRTL strongly urges those still thinking about using an advance directive to carefully consider if it is appropriate for them or their loved one.

Nevertheless, if anyone wishes to use an advance directive, the following is a partial list of things to consider:

(Note: This is not medical advice. Anyone considering an advance directive is strongly encouraged to consult a pro-life physician and  attorney for professional guidance).

  • Pray about how to approach an advance directive.
  • Avoid using vague language, such as: “I don’t want to be a burden to my family.”
  • Make it clear that you do not want care givers to prolong the dying process, or do anything that directly causes your death.
  • Appoint a trusted relative or friend who clearly understands your wishes to act as your Health Care Agent or Medical Power of Attorney if you’re unable to speak for yourself.
  • Make sure you fully discuss your desires with your Medical Power of Attorney or Health Care Agent.
  • Choose a physician who does not have a “right to die” bias.

As Muriel Gillick, a geriatrician at Harvard Medical School and researcher in end-of-life care, wrote in the New England Journal of Medicine, “Despite the prodigious effort devoted to designing, legislating, and studying of advance directives, the consensus of medical ethicists, researchers in health care services, and palliative care physicians is that the directives have been a resounding failure.”

Sources: amednews.com; dhr.georgia.gov; wf-fy.org (article by Nancy Valko); ABA Commission on Legal Problems of the Elderly.

By Wayne DuBois
Media Relations Advisor