Hospital care not affected by advance directives
It's official: living wills have little or no effect on actual hospital care. That's the consensus outlined in a report in the May issue of the journal Critical Care Medicine.
While few elderly patients who are critically ill have advance directives, the researchers point out, the level of care delivered in the intensive care unit (ICU) is not affected by the presence or absence of advance directive statements. The research was conducted at the Robert Wood Johnson Medical School in Camden, NJ.
Advance directives usually are attached to patients' medical charts to notify providers of their choices and wishes regarding the use of artificial life support or other end-of-life interventions.
Researchers reviewed the medical records of 401 ICU patients ages 65 and older to determine the prevalence and relevance of living wills in real-life hospital scenarios. They found that 5% (19) of critically ill elderly patients had written an advance directive. All 19 forbade the use of cardiopulmonary resuscitation (CPR) in the event of heart attack. Twelve dictated they did not want artificial feeding or respiration should they become incapacitated. Seven refused the use of intravenous medication under such circumstances.
The medical records of these patients, however, revealed that the existence of an advance directive in the hospital did not influence the level of overall medical care. In fact, two out of the five patients with advance directives who died received CPR despite instructions to forgo the procedure, the researchers note. Also, no significant differences were found in the overall ICU costs of patients with and without advance directives.
Researchers say health care providers often are unaware of the advance directive statement or the fact that one exists on the chart. They also note that health care staff rely on the results of tests and invasive monitoring to make decisions unbiased by the advance directive statement.
· The 12th World Congress on Medical Law. Aug. 2-6, 1998. Siofok, Hungary. Sponsored by World Association for Medical Law. Co-sponsored by World Health Association, Council for International Organization of Medical Sciences, and International Council of Nurses. Contact: Organizing Secretariat, World Congress on Medical Law, MOTESZ Congress Bureau, H-1051, Budapest, Nador u. 36. Hungary. Phone: (361) 111-6687. Fax: (361) 183-7918.
· Summer Seminar in Health Care Ethics. Aug. 3-7, 1998, University of Washington School of Medicine. Sponsored by Department of Medical History and Ethics. Contact: Marilyn J. Barnard, Program Coordinator, Medical History and Ethics, Box 357120, School of Medicine, University of Washington, Seattle, WA 98195-7120. Phone: (206) 616-1864. Fax: (206) 685-7515. E-mail: [email protected].
· Annual Meeting. Oct. 9-10, 1998, Cambridge, MA. Sponsored by the American Society of Law, Medicine, and Ethics (ASLME). Contact: ASLME, 765 Commonwealth Ave., 16th Floor, Boston, MA 02215. Phone: (617) 262-4990. Fax: (617) 437-7596. E-mail: [email protected]. World Wide Web: http://www.aslme.org.
· National Bioethics Advisory Commission 1998 Summer and Fall Meetings. All meetings open to the public. Anyone wishing to present oral statements should contact the commission as soon as possible at 6100 Executive Blvd., Suite 5B01, Rockville, MD 20892-7508. Phone: (301) 402-4242. Fax: (301) 480-6900. World Wide Web: http:// bioethics.gov/bioethics/meetings/html. Dates and locations include July 14-15, Portland, OR; Sept. 16-17, Washington, DC; Nov. 17-18, Miami.
· First Annual Meeting. American Society for Bioethics and Humanities, Nov. 18-21, 1998, Houston. Contact: American Society for Bioethics and Humanities, 4700 W. Lake Ave., Glenview, IL 60025-1485. Phone: (847) 375-4745. Fax: (847) 375-3777. World Wide Web: www.asbh.org.
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