Many agencies and nonprofit organizations that tout living wills are reporting a sharp increase in people seeking the documents because of the Schiavo case, so you can expect more patients to show up with questions about them or clutching a living will that they downloaded off the Internet.
That’s not good news for a risk manager, says researcher Angela Fagerlin, PhD, a research scientist with the University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System. The recent flurry of advice about living wills will result in people signing the documents without the necessary reflection, she cautions.
"People are saying these documents are the solution the problems in the Schiavo case, which is not true, and so they’re finding a standard living will form somewhere and signing it," Fagerlin says. "They’re doing it without putting enough thought into these very, very important decisions. If they say they don’t want mechanical ventilation, have they considered that they might get pneumonia and need a ventilator for just a couple of days?
"Are they saying they would rather die than do that?"
Health care providers are obligated under the federal Patient Self-Determination Act to tell patients about living wills and other advance directives, but Fagerlin says risk managers should make sure that patients are informed about the limitations of living wills and the other options, such as a durable power of attorney.
Patients may get the impression that a living will is necessary to avoid prolonged life support, having no idea that a surrogate can be designated to make decisions at that time instead of trying to specify preferences now. See questions about a living will as an opening for a more thorough discussion of options, Fagerlin suggests.
"Encourage people to consider the situation more thoroughly, because they may not have even read the living will they downloaded off the Internet," she says. "Remind people that this is a very serious decision they’re making and they need to fully consider all the ramifications. Make sure they know that there may be a better way to have their wishes carried out, a better way than this one document they’ve heard so much about."
Many agencies and nonprofit organizations that tout living wills are reporting a sharp increase in people seeking the documents because of the Schiavo case, so you can expect more patients to show up with questions about them or clutching a living will that they downloaded off the Internet.
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