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Are advance directives effective?

Imagine that you are caring for Ted, a patient in hospice who would like to go from Los Angeles to Michigan to see his family one last time. His same-sex partner opens up to you that he is worried about what would happen if Ted became sick while in Michigan, as his family there are very religious and don’t necessarily agree with Ted's end-of-life wishes. Not to worry, you say, Ted has a valid advance directive that his same-sex partner is his health care agent. Then you pause and think. Hmmm… Maybe there is something to worry about.

That is the start of a great post by Dr. Eric Widera at the blog Geripal.  What a dilemma, huh?  Dr. Widera, a palliative care and geriatrics specialist at UCSF, does an excellent job using this setup to dissect the recent journal article in the Annals of Internal Medicine, Lost in Translation: The Unintended Consequences of Advance Directive Law on Clinical Care.

The key findings include the following five barriers to effective advance directives:

  1. Inadequate reciprocal recognition among states
  2. Restricting surrogate decision makers
  3. Poor readability
  4. Burdensome requirements to complete advance directives
  5. Religious/social/cultural concerns
Dr. Widera goes into details on these barriers in his post.  Thankfully the authors of the article suggest some solutions.  And the many people who support National Healthcare Decisions Day have some great solutions too:

The great thing to see is that many people are talking about this issue on the Geripal post.  Go add your two cents just like the NHDD Chair Nathan Kottkamp did!