A recent New York Times article http://newoldage.blogs.nytimes.com * noted: “Calling 911 can cause particular problems…Emergency medical personnel want orders…Nothing else has been shown to be effective.”
“Health care professionals, ethicists and advocates continually urge older people to document their preferences about end-of-life medical decisions, and a growing proportion do. A recent large national study, tracking more than 6,000 people over age 60 who died between 2000 and 2010, found that the proportion with advance directives climbed to 72 percent from 47 percent.”
“But how much does it matter? How often are people’s advance directives ignored or overridden? Do they really ensure that the elderly get the care they want or ward off procedures they don’t?”
A “… large national study concluded that having advance directives had little effect on whether people were hospitalized and how often, or whether they died in hospitals. Yet where someone dies has considerable impact on how.”
“Sometimes… people fill out forms but never have thoughtful conversations with family members or doctors. They choose ineffective proxies. Family members disagree about treatments. Administrative errors – the wrong box checked on a form – interfere.
“What do we do, then, to maximize the chances that our elders’ wishes – or our own – prevail? Eventually, electronic health records may help. Meanwhile, the best advice…is that everyone should have an advance directive, discuss his or her decisions with doctors and family members, and appoint a strong health care proxy. Then that person has to physically shove the appropriate forms under people’s noses at every hospitalization, every visit to a new physician, every transfer to a nursing facility.”
* to read the full NYT story “The New Old Age: When Advance Directives Are Ignored “ by Paula Span, hioghlight and click on open hyperlink http://newoldage.blogs.nytimes.com/2014/06/24/when-advance-directives-are-ignored/?_php=true&_type=blogs&_r=0
Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options.
Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
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