Rx for Health Care: The Advanced Directive

The image is a haunting one: a dying patient whose suffering is needlessly compounded by unwanted, invasive and expensive medical treatment.

That’s an outcome few of us want, a sentiment clearly underscored in a 1995 study conducted by the American Medical Association. This landmark six-year study, financed by the Robert Woods Johnson Foundation to the tune of $28 million, analyzed trends at six medical facilities around the country. It revealed that 75 percent of those participants surveyed thought it a good idea to have a living will – a document that allows a patient to specify what kinds of medical treatment he or she will receive and under what circumstances.

Yet, despite the overwhelming weight of public opinion in favor of the living will, fewer than one in three Americans have one.

Even those who do shouldn’t be complacent about the care they may receive at the end of their lives. That’s because the same AMA study documented that few patients had their wishes met, even when those wishes were explicitly stated in their living wills. Instead, caregivers routinely ignored patients’ instructions, applying medical treatment that patients had specifically elected against. Or when caregivers did comply, they often did so only after days or even weeks had elapsed, during which time the patient received unwanted care. In fact, the study’s dismal conclusion was that in 80 percent of the cases reviewed, patient’s instructions were ignored.

Part of the reason why living wills fail to provide patients with the desired control over their care, according to the AMA, is that these documents are often vague and confusing. That weakness is compounded by the fact that a living will doesn’t empower anyone to act on the patient’s behalf, a serious shortcoming.

That’s why growing numbers of observers and the AMA itself have taken up a campaign for advanced directives in place of living wills. Properly drafted, an advanced directive works like a living will teamed with a health care power of attorney. It will typically provide caregivers with greater detail about the care a patient wishes to receive, and, perhaps most importantly, it authorizes a trusted loved one, family member or professional advisor to make decisions on the patient’s behalf.

Study after study has demonstrated that this advocate on the scene is absolutely essential to ensure that the patient’s desires are carried out. Caregivers, who have devoted their professional lives to providing medical treatment, often find it difficult indeed to withhold it, no matter what the circumstances. Having an advocate at the patient’s bedside speaking on his or her behalf and demanding that the patient’s wishes be carried out can make the difference between a death with dignity and a lingering end filled with suffering and costly medical treatments.