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Fast Fact and Concept #12: Myths about Advance Directives

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Title: Fast Fact and Concept #12: Myths about Advance Directives

Author(s): Warm, E.; Weissman, D.

Written advance directives are legal in every state; however, laws of each state can vary widely. You can find information at http://www.choices.org/ad.htm . There are two types of advance directives:

Health care power of attorney (aka: durable power of attorney for health care, health care agent, etc.) - a document in which the patient appoints someone to make decisions about his/her medical care if he/she cannot make those decisions.

Living will - a written document in which a patient's wishes regarding the administration of medical treatment are described if the patient becomes unable to communicate at the end of life.

Here are 8 common myths regarding advance directives:

MYTH 1: There is only one type of power of attorney. False - many patients (and their families) believe that if they have power of attorney for financial matters, they also, by default, have power of attorneyfor health care. These are typically separate legal documents, but sometimes are combined into one comprehensive document prepared by an attorney.

MYTH 2: . It is not appropriate to begin advance directive planning on an outpatient basis. False--many studies have shown that patients want their doctors to discuss advance care planning with them before they become ill. Many others have shown a positive response from patients when advance directive discussions are held during outpatient visits.

MYTH 3: An advance directive means "don't treat". False - Too often advance directives are triggers for disengagement by the medical staff. Advance directives do not say "don't treat me". They say, "treat me the way I want to be treated".

MYTH 4: Once a person names a proxy in an advance directive they lose control of their own care. False - as long as a person retains decision making capacity he/she retains control of their medical destiny.

MYTH 5: A lawyer is required to complete an advance directive. False ? a lawyer may be helpful, but is not required. Again, check your own state requirements for the number of witnesses or need for a notary public seal.

MYTH 6: Doctors and other health care providers are not legally obligated to follow advance directives. False ? doctors and other health care providers are obligated to follow advance directives; however, they often do not. The SUPPORT trial concluded only about half of all physicians in the study even knew what their patients wanted at the end of life.

MYTH 7: Advance directives are legal tools for old people. False ? the stakes may actually be higher for younger people if tragedy strikes (think Nancy Cruzan or Karen Ann Quinlan).

MYTH 8: The doctor can be the named agent in a durable power of attorney for health care document. False - no member of the health care team can be the agent named by the patient in a durable power of attorney for health care document.

References:

Aitkin PV, American Family Physician 1999;59(3):605-612 (SUPPORT), JAMA 1995;274:1591-1598

Sabatino CP, http://www.abanet.org/elderly/myths/html 10 Legal Myths About Advance Medical Directives

Fast Facts and Concepts are developed and distributed as part of the National Internal Medicine Residency End-of-Life Education project, funded by the Robert Wood Johnson Foundation.

Disclaimer Concerning Medical Information

Health care providers should exercise their own independent clinical judgment. Accordingly, official prescribing information should be consulted before any product is used.

Creation Date: 4/2000

Format: Handouts

Purpose: Instructional Aid, Teaching

Audience(s)
Training: Fellows, 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice
Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
Non-Physician: Clergy/Chaplains, General Public, Graduate Students, Lawyers, Patients/Families, Nurses, Social Workers

ACGME Competencies: Interpersonal and Communication Skills, Medical Knowledge, Patient Care

Keyword(s): Adult, Advance directives


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