UW Wisconsin study says surgeons are wary of advance directives

A recent study by a University of Wisconsin Madison surgical professor suggests that advance directives, or "living wills," may impede the work of surgeons, even causing some to refuse treatment of those with advance directives preventing the use of extraordinary measures.

The findings of the study were published online by Annals of Surgery and later in a University of Wisconsin Madison news release on Thursday. Some have said the study is "troubling."

According to the study, high-risk surgeons may find themselves in a difficult situation when trying to save the life of an individual who has expressed a desire to forgo extraordinary measures. Because of this, only 50 percent of surgeons who do high-risk operations discuss advance directive with their patient prior to surgery. And 54 percent said they wouldn't operate on a patient if had a directive limiting the use of life support in post-operative care, in cases where the surgeon believed it would be necessary for the patient's survival.

The study was based on a survey of over 900 cardiothoracic surgeons, vascular surgeons and neurosurgeons. All the surgeons who participated said they discussed to possibility of a poor outcome with their patients, and nearly all of them said they discuss the need for post-operative life-supporting therapy.

Only 52 percent of the doctors said they asked patients if they had written advance directives. Some surgeons say they do not believe that going by an advance directive works well for surgery, and that it is preferable to have a conversation with the patient about their priorities in the event something goes poorly.

The study, while it does not undermine the importance and value of advance directives as an estate planning tool, does indicate the need to be in better dialogue with one's surgeon about goals and priorities.

Source: The Cap Times, "Can 'living wills' tie a surgeon's hands? UW study indicates so," Bill Novak, January 26, 2012.

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