Health care directives not always honored

Advance directives, for those who’ve done research on the topic, are instruments that provide tools for folks to handle their medical care in the event they lose the ability to make such decisions. In Georgia, state law provides the opportunity for people to select a health care agent to make decisions on their behalf, as well as to express their wishes regarding specific treatments or courses of care.

Research on the effectiveness of advance directives is not all hopeful. In fact, some research shows that advance directives are not always consulted when they could be, and that they are not always honored when they have been consulted. In some situations, a patient’s advance directive simply cannot be found. In some cases, patients end up changing their minds about the treatment they want, and they have not updated their advance directive or told their family. 

Some professionals, in light of the fact that decision-making in a hospital setting is not easily controlled, believe it is better to write as little as possible into one’s advance directive. Rather than multiplying the details of treatment preferences, it may actually be better to keep things simple.

This advice, of course, will not necessarily apply with equal validity to everybody. Much of it depends on how families work through decisions, particularly difficult decisions. Families who take seriously the preferences expressed in an advance directive will have a different experience than families who ignore a directive.

So, based on the research, it may be that the most critical factor in having an advance directive enforced is not the mere execution of the document, but getting the family on board. There may be things one can do to this end, but probably the simplest thing is to communicate one’s wishes, perhaps providing a copy of the directive to key family members. Needless to say, the individual selected as a health care agent should be trustworthy and should understand the importance of following the directive. 

Source: BioEdge, “Advance directives are often not honored,” Michael Cook, June 29, 2013. 

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