For advance directives,
a picture’s worth a thousand words
Newswise — Ray Moseley sees the
trouble with advance health-care directives every time he speaks to
a group of senior citizens: Several in the crowd always know someone
who had a living will but whose end-of-life decisions were not
honored anyway.
Ambiguity, objections and even
fear cause families and physicians to ignore the decisions listed in
advance directives more often than most people think, violating a
patient’s right to refuse treatment, says Moseley, Ph.D, a
University of Florida bioethicist. But he and two other researchers
have envisioned an idea that could make end-of-life decisions easier
to decipher.
Videotaping an advance directive,
the researchers explain in an article recently published online in
the Archives of Geriatrics and Gerontology, would allow people to
express medical decisions to their physicians and families in a way
legal documents do not allow – face to face.
“Studies have shown that advance
directives, in spite of the idea that we should honor an
incapacitated person’s wishes, just simply don’t work very well,”
Moseley said. “There’s this growing frustration out there that
written advanced directives aren’t working and there don’t seem to
be any alternatives. We’re offering an alternative.”
Moseley said the problem isn’t the
message of advance directives, which have been used for about 30
years and allow people to plan ahead for their health care should
they become seriously ill. Advance planning can keep people from
battling about end-of-life decisions in court, like the family of
Terri Schiavo, a Florida woman in a persistent vegetative state
whose husband and parents fought for years about whether her feeding
tube should be removed.
But a written advance directive
doesn’t always stop the bickering among families, Moseley said.
Seeing a relative explain his or her decision in a video could quell
some of the discord, the researchers suggest. A videotape could spur
discussions at home about death, too.
“None of us like talking about
end-of-life issues,” he said. “We are a death-denying culture. But
that’s only one little part of (the problem). The big part of it is
the medium.”
A written advance directive often
raises more questions for doctors than the document answers.
Physicians don’t always know if their patients were coherent when
they signed the form or what they meant by certain terms like
“terminal.” And many physicians in hospitals are caring for
incapacitated patients they’ve never met before, let alone when they
were healthier and still coherent. This confusion about a
life-or-death issue can force doctors to make conservative treatment
choices, ones that may not coincide with what a patient expressed in
an advance directive, Moseley said.
“Some of the most difficult
situations – difficult for families, patients and physicians –
revolve around advance directives,” said Robert Hatch, M.D., a UF
associate professor of medical education who contributed to the
report along with another researcher from the University of
California at Los Angeles.
Hatch said a doctor with a full hospital schedule probably faces an
advance directive problem every other month.
Most doctors are uncomfortable
relying on a legal document to determine whether a patient lives or
dies, said Kenneth Goodman, Ph.D., a University of Miami bioethics
professor and the director of the Florida Bioethics Network.
But with technological and medical
advances keeping patients alive longer than they did 50 years ago,
advance directives are becoming increasingly important, he said.
“Advance directives are a very
important way to let your wishes be known,” he said. “(Video) is a
very creative way of demonstrating what you want. I think it’s a
good idea.”
The researchers don’t think the
written form of advance directives should be scrapped though. They
see video as a supplement. While many states would accept a video,
some states require an advance directive be signed to be legally
binding. In Florida, an advance directive does not have to be
written but must be witnessed to be legal.
Moseley notes that video living
wills may not solve every problem. He said he thinks the idea needs
to be studied further and people need to learn to accept others’
wishes so a patient’s rights are never violated. But for most
families and doctors, Moseley said video is one step closer toward a
conversation and potentially, one step closer toward acceptance.
“Our goal should be to honor a
patient’s wishes as best we can, and a video living will would
significantly help,” he said.
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