Thursday, April 16, was National Healthcare Decisions Day. We probably should have made note of it.
But then again, we’ve pretty much ignored it since one post I wrote in 2008 making note of the day and NDY’s take on it:
In case you missed it, today is National Healthcare Decisions Day (NHDD). We’re all invited to “join Americans across the country to talk to others about your future healthcare decisions and to complete your advance directive!”
We’ll pass, at least when it comes to joining with the coalition promoting this effort.
We listed some of our reasons and rationale for opting out:
There are many problems with the marketing and the promotion of advance directives right now, but I’ll focus on two:
- There is no warning to the public that advance directives might not be of any use at all if physicians don’t agree with your choices. Under the ever-increasing influence of “futile care” policies, physicians and hospitals may deny you life-saving treatment even if your advance directive calls for it and your health-care proxy demands it. At least part of the reason this “elephant in the living room” isn’t addressed may be that many of the medical organizations participating in NHDD support “futile care” policies.
- In discussions with disability advocates, advance directives are described as a way to state what you do want in the way of treatment as well as what you don’t want. And, in all fairness, some of the forms being used provide space for those options of desired treatments. However, the long-term focus on – and usage of – the problematical term “end of life,” has resulted in “advance directives” being framed as an “end of life” issue, as can be seen in the “facts” section of the NHDD website. On this page, you’ll see that the discussion quickly leaps from “advance directives” to “end of life” issues. This inevitably encourages most people to think about “advance directives” as being about ending their lives, rather than making a clear statement of “treatment preferences.”
So forgive us if we don’t join the current effort. We do think it’s best to make sure you pick someone you trust to make decisions on your behalf should you need that while in the hands of the medical system. We just don’t want to sign onto this flawed effort and product.
There’s little evidence that there’s much that’s gotten any better, so there’s little to give us reason to summon up some enthusiasm for the day.
But we do have something to share.
In 2013, NDY President and CEO Diane Coleman submitted comments to the Institute of Medicine’s Committee on Approaching Death. The comments included this:
A 2012 study in the Journal of Emergency Medicine[14] found that having a living will might give people a false sense of security about getting the treatment they want. Based on survey responses from more than 700 physicians in 34 states, researchers from the University of Pittsburgh Medical Center found that over 50% of physicians misinterpreted a living will as having a “do not resuscitate” (DNR) order when it did not. About the same percentage over-interpreted DNR orders as meaning no treatment except “comfort care” or “end-of-life” care.
The study shows that there is a frighteningly high likelihood that having a living will or DNR order will result in physicians withholding curative treatment that a patient actually wants. What are the reasons for the interpretation problems that have been documented? And what are the risks that the same type of misinterpretation is or will be an issue in the POLST context? Research is needed before sound policies can be developed. (Here’s a link to the abstract of the study cited here.)
That brings me to the present. This morning, Dr. Ferdinando Mirarchi, lead author of the article discussed and cited above, emailed Diane Coleman with a video to share. The video, “Good Practice,” is by Emergency Room physician Dr. Michael Barton. The video is close captioned and has additional text embedded in the video; they don’t get in the way of each other – much. 😉 Video below. Enjoy!