Problems With Boilerplate Advance Directives

An advance directive is a legally valid form that enables a person to choose the type of medical care he or she wishes to receive.  It goes into effect when that person is no longer able to speak for himself.  Nursing homes typically highlight advance directive completion rates with pride, as an attempt to show they are concerned about patients’ preferences. 

However, advance directives that come from nursing homes are cookie-cutter similar.  Almost all indicate that a patient has stated that all attempts to prolong life should be pursued and no treatment is unacceptable—regardless of prognosis.  The witnesses are typically the admissions clerk and the social worker, hardly ever the physician. 

Unfortunately, this is the reality for many individuals.  Discussing values, preferences and goals in the event of debilitation is difficult and time consuming.  Since nursing homes are paid to care for patients in perpetuity, their employees may not be the right people to oversee the completion of these ever-important forms.  It may be time to begin questioning our blind trust in patient autonomy.  This may be in fact harming, rather than helping patients nearing the end of their lives.  Thus, in order to obtain better care, and to provide it, directives need to be created, updated, accessible and incorporated into treatment.

See Jessica Nutik Zitter, When ‘Doing Everything’ Is Way Too Much, The New York Times, Feb. 7, 2015.

Special thanks to Jim Hillhouse (Professional Legal Marketing (PLM, Inc.)) for bringing this article to my attention.