Small Study Finds that Decision-Makers Take 40 Percent Longer to Discontinue Life Support in the Absence of Previous Health Care Discussions with Affected Patients — the Importance of Advance Health Care Directives and Agents

© 2011 Peter Free

 

21 January 2011 (revised 23 September 2016)

 

 

Confronting mortality is an important part of wise health and estate planning — too few of us do it

 

Filling out an advance health care directiveand appointing a health care agent — via a durable power of attorney for health care decisions or medical power of attorney — are important elements of personal preparedness.

                    

Most people avoid doing both, apparently under the illusion that not planning for the end of life will indefinitely stall its occurrence.

 

The oversight is often financially costly and poses psychological burdens for the people who have to pick up the pieces, when the inevitable happens.

 

 

The study measured the delay that occurs in the absence of end-of-life health care planning

 

According to the University of Pittsburgh:

 

Family caregivers who had not discussed life support measures with critically ill patients took nearly two weeks longer to decide to forego further medical intervention than those who had prior conversations about the issues, according to researchers from the University of Pittsburgh School of Medicine and the Graduate School of Public Health. They share their findings in a poster presentation at the Society of Critical Care Medicine congress this week in San Diego.

 

For the study, conducted at four intensive care units at the University of California San Francisco Medical Center between 2005 and 2008, the researchers surveyed 230 caregivers who were making decisions on behalf of incapacitated patients on ventilators with greater than a 50 percent chance of dying from their illnesses.

 

They found caregivers who hadn’t had a prior conversation with patients about treatment preferences were less confident about making decisions and it took them 40 percent longer – 33 days versus 21 days – to decide to discontinue life support.

 

“This prolongation of the dying process may not be in the best interest of patients and it places an enormous burden on the health care system,” Dr. White said.

 

© Can We Talk? Life-Support Decisions Take Longer When Patients and Family Caregivers Don’t Discuss Treatment Wishes, Pitt Study Finds, University of Pittsburgh: Schools of the Health Sciences Media Relations (19 January 2011)

 

 

 

Talk about "end of life" and "in case of accident" issues

 

The easiest way to do this is to fill out an advance directive and power of attorney for health care.  Completing the forms requires us to think about what we want.

 

 

Some states make the planning easy and free

 

Obviously, asking your attorney for help with this is a good way to go. The financial aspects of estate planning can be covered, as well.

 

However, for the purely medical side of things, you can use an Internet search engine to track down advance directive and agent for health care forms that are specific to the state where you live. For example,  CaringInfo — a website created by the National Hospice and Palliative Care Organization — provides links to state Advance Directive forms.

 

Sensibly cautious people will want to track down their applicable state statute to make sure the form they find online is adequate.

 

 

For example

 

California incorporated forms directly into its authorizing statute.  The statutory database is here.  If you search for “advance health care directive,” in the Probate Code, you will find it under § 4701.  The “power of attorney for health care” is part of the same form.

 

Oklahoma did the same thing.  Its online statute database is here (operated by the University of Oklahoma College of Law).  Using the search function will turn up a form that covers both the advance directive and the power of attorney.

 

Even if you do not think of going directly to state statutes, some jurisdictions make it easy to find what you need.

 

Using Oklahoma as an example again, “advance directive for health care” took me to the appropriate section of the Attorney General’s Office.  That linked me to the University of Oklahoma’s College of Medicine Palliative Care Resource Center, where another link connected to Oklahoma’s “advance directive for health care” and its included, “my appointment of my health care proxy” here.

 

 

The moral? — Confronting inevitable issues is better done now

 

Filling out an advance health care directive and appointing a health care agent is important.

 

If you procrastinate — hoping to dodge the inevitable — things that you do not want to happen to you likely will.

 

Many of the people I talk to have no idea what they want for themselves, much less someone else.

 

Keep in mind that — in the absence of a chosen health care agent and even if you already have an Advance Directive — it is unlikely that everyone in your family will agree about how to interpret that document.

 

End of life medical issues often play out over substantial time and in evolving and increasingly intrusive ways. It is a good idea to have someone knowledgeably close to you oversee the process.

 

Fill out your paperwork now and avoid unnecessary problems.