Have Advance Directives Failed? Essay

In this paper, I will discuss advance directives, what it is, and the reason for it. I will talk about the issues that are currently facing advance directives care and talk about whether it has failed, or not. Finally, I will prove my stand on the issues with evidence. What is Advance Directives? An Advance directive is a living will, which allows one to document their wishes concerning medical treatments at the end of life. Even though it’s optional, but all health care facilities are required by law to ask patients if they have one, and offer them the appropriate information, and documents to sign if they want it.

There are two basic kinds of advance directives, living wills, and durable powers of attorney for health care. Advance directives are legally valid throughout the United States, but the laws governing advance directives vary from state, to state. Anyone can have advance directives, no lawyer is required, and it becomes valid as soon as you sign it in front of the required witnesses. Anyone can be a witness. Reasons for advance directives Advance directive is designed to empower patients, and to allow them to have a voice in their care.

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It provides a way for patients to communicate their wishes to family, friends and health care professionals, when they are no longer able to do so. With advance care directives, you can express how much, or how little care you want done for you when you are no longer able to make these decisions for yourself. You can also appoint someone to make decisions about your medical treatments when you are unable to make these decisions yourself; this is called power of attorney. Another reason for Advance directives is to protect your right to die with dignity.

It allows your voice to be heard when you can no longer speak. It relieves your family the burden of figuring out what you want, and deciding for you. The Issues Affecting Advance directives The issues facing advance care directives are both legal and ethical. In most states, the law requires you to be eighteen or older in order to be able to make informed decision on your own. Therefore if you are under eighteen year of age, your parents have to make the decision for you.

The court of law can also deem one as incompetent to make their own informed decision; this may be due to injury or disability. Then, the court will appoint a proxy, or a guardian who will make the health care decision for that person. In the event of sickness, car accidents, and emergencies, if the person has no living will, and there is no durable power of attorney for health care; then the law in most states permits health care practitioners to turn to next of kin as default surrogate decision-makers.

The selection of next of kin starts from the person’s spouse, or (domestic partner as allowed by law in that state) then an adult child, a parent, a sibling, and then possibly other relatives, and in some states friends can be included. Recently, I heard a story from National Public Radio (NPR) in a program called “All Things Considered”. The story was about a memorandum issued by President Obama in April 15th 2010 to “allow designated non-family members to visit patients and participate in health care decisions” (Lee. 2010).

The memorandum was to enable gay and lesbian couples a visitation right. This causes a lot of ethical debates about whether the gay should have this right. Also, not long ago, the U. S. Conference of Catholic Bishops, instructed Catholic hospitals to ignore advance directives if they meant someone would die because of them. Their reason is that, Catholic health facilities have “an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who could not take food orally” (Meyer, 2010).

Though I believe that advances directives are good and have so many benefits, but at the same time, I believe that it has failed for so many reasons. These stem from lack of people’s interest in completing the form to inaccessibility of advance directives. Also, there is a cultural and religious belief, that contradicts advance directives and because of all these, I believe it has failed. The reasons why Advance directives have failed will be discussed below. The Complexity of the Form and People’s Lack of Interest Advance directive forms are difficult to fill out.

People who graduated from high school find it difficult to fill, and even more difficult to our elderly population who are mostly illiterates. Some people just don’t understand the medical care, and the technical language involved. The elderly people don’t understand the questions, which cause them to be misrepresented. For example, patients may request cardiopulmonary resuscitation (CPR) on the basis that they think they will have 100% survival rates, but according to Levine (2010), the actual rates are only 0-22% depending on the medical circumstances (p. 3). Many people might decline CPR if they know this. Another reason that it fails is because of people’s lack of interest, most people don’t want to think about death, despite all the benefits of advance directives. In one study of nursing home residents, 90% had heard of a living will, but only 18% had signed one; 30% had heard of a durable power of attorney, but only 15% had appointed a decision make (John La Puma, David Orentlicher, & Robert J. Moss, 1991).

People often procrastinate when it comes to filling out Advance directives because of the thought of death, but when we start filling it out we don’t complete it. This may be the reason why so few patients sign the advance directives. As stated by Levine (2010), “completion rates among patient groups run only 4% to 25%” (p. 63). Inaccessibility Another reason why I think advance care directives have failed is because, it is not always accessible. Some people don’t remember where they put them or either in the vent of emergency, it is with a family member, and they are on vacation.

Others locked it up in safe deposit box, thinking that it will be safe there until they need it, but when emergency arose such as car accident, advance directive is not there where it is needed most. Healthcare Facilities Contribution to the Failure Hospitals and other health care facilities also contribute to the failure of advance care directives, by failing to include copy of the patients advance directives in his or her chart. Physicians may be unaware of a patients advance directives, even when the document is placed in the patients chart.

Healthcare directives have failed because, we as healthcare providers don’t enforce it. For example, upon admissions we may ask the question do you have one, but we do not express the importance of an advance care directive to our patients. Failure of an advanced care directive can simply be because; the form was started but never completed. Due to human factor mistakes sometimes happen, a person that has chosen “Do not resuscitate” may be resuscitated, and prolong his or her life vice versa.

In an emergency situation especially those that occur outside the facility, advance care directives may not apply because emergency medical services (EMS) are generally required to keep patients alive. Religious Beliefs and Cultures There are people whose religious beliefs prohibit them from having health care advance directives and there are some who have advance directives, and their religious facility refuse to honor it. For example, in 2009, there was an elderly woman who suffered a massive stroke and could no longer speak, eat or drink. She was taken St.

John Medical Center in Tulsa, Oklahoma, a catholic facility. Although the woman had an advance directive, specifying no artificial hydration or nutrition if she weren’t going to recover, but the facility refused to honor her request. Their reasons as stated by one of their bishop was, If a patient or family didn’t want a feeding tube, “and the reason they don’t want it is they basically want to die, then the Catholic institution would explain to them they can’t cooperate with that and they would have to go to another institution. ” said the Rev. Thomas G.

Weinandy, executive director for doctrine at the bishops’ conference, who helped draft the policy (Meyer, 2010). Culture can be a hindrance to advance directive, people from traditionally disenfranchised populations, especially people who are poor or minority groups, may fear that an advance directive would be used to limit other types of medical care. Furthermore, Young people often think that they do not need advance directives because they think they are too young to worry about death. Conclusion This paper has discussed the issues that are affecting ‘Advance care directives.

Some of its failures which are due to the wording and the ambiguous terms, which is often open to different interpretations. I believe that advance directives need to be revamped. Advance directives need to be written in clear and concise language, so that it will be easy to interpret and apply. Government needs to make the public and medical providers, more aware of advance directives, thus making them more accessible. Special consideration needs to be made for those with religious beliefs that contradict advance directives. I believe if all this is done, then advance irective will be better and widely used.


John La Puma, M. , David Orentlicher, M. J. , ; Robert J. Moss, M. (1991). Advance Directives on Admission Clinical Implications and Analysis of the Patient Self-Determination Act of 1990. JAMA , 402-405. Lee, B. C. (2010). Hospitals Ordered To Follow End-Of-Life Care Wishes. Washington: NPR News. Levine, C. (2010). Taking Sides: Clashing Views on Bioethical Issues. (13th ed. ) New York: McGrawHill. Meyer, H. (2010, Feb 27). Catholic Directive May Thwart End-Of-Life Wishes . Kaiser Health News , p. 1.