Frank Carter, MD
Potential Financial Conflicts of Interest: None disclosed.
Carter F.; Can't We Improve on Advance Directives?. Ann Intern Med. 2008;148:405. doi: 10.7326/0003-4819-148-5-200803040-00019
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Published: Ann Intern Med. 2008;148(5):405.
TO THE EDITOR:
I share Perkins's hope for improvement in advance care planning (1), and I would like to share an observation from a primary care practice of more than 30 years. During this time, I have offered advance directives to all my patients and discussed the broad concept with them. Although few have completed the advance directive, essentially all patients have expressed the wish to forgo life support in a situation that looks hopeless (one patient was willing to say only that she wanted her family to make decisions if she were unable). I have noted this wish in my patients' records and have found that notation helpful in subsequent end-of-life discussions with families. On the basis of this observation, I think the greatest flaw in the concept of advance directives may be the underlying assumption that, unless otherwise indicated, people want to be kept alive in such conditions as a persistent vegetative state. It might make more sense to continue to make advance directives available to everyone, but to shift the burden of necessary documentation to those rare individuals who want to continue care that seems futile to their medical providers.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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