The Trouble With Advance Directives
Ever since Congress passed the Patient Self-Determination Act in 1990, health professionals and consumer advocates have urged Americans, especially older adults, to draw up advance directives and distribute them to families and doctors. The documents allow people with terminal illnesses to accept or reject medical interventions and to appoint surrogate decision makers if they become incapacitated.
The campaign does seem to have paid off in one sense: Among Americans over age 60, the proportion who had advance directives when they died rose to 72 percent in 2010 from 47 percent in 2000, according to data from the national Health and Retirement Study.
Too often, though, an advance directive hardly seems to matter. Stories abound of documents misplaced, stashed in safe deposit boxes, filed in lawyers’ offices.
Frequently, “the directive never gets to the right place, or isn’t referred to when a decision needs to be made,” said David M. English, chairman of the American Bar Association’s Commission on Law and Aging. Emergency medical personnel operate under standing orders to attempt resuscitation, whatever an advance directive says. (Only a state do-not-resuscitate or Polst form can prevent that.)
The Polst form does a better job than advance directivesof keeping dying people out of hospitals, research has shown. Completed by health care professionals in consultation with patients, this document can stipulate that only comfort measures be applied, or full life-prolonging interventions — or various options in between.
But a Polst can’t always substitute for an advance directive. It is meant for people with with serious illnesses that could result in their death within a year. Most people over 65 are still too healthy to have a Polst.
My advice is to always start by giving a copy of your Power of Attorney to your primary care physician. If you have a very serious illness consider a Polst.
Read about this in a New York Times article on March 13, 2015 written by Paula Span at http://nyti.ms/18Hg8hP
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