The American Medical Association strongly supports advance directives and durable power of attorney for health care.
About 40% of hospitalized patients have some diminished decision-making capacity.
The durable power directive does not set out specific instructions about ventilation, artificial hydration and so on, but instead requires only that patients name loved ones they trust to make treatment decisions, should they become incapacitated.
The American Bar Assn.'s Commission on Legal Problems of the Elderly says "most people should have a health care power of attorney" and lists as a "myth" the notion that "everyone should have a living will."
Rebecca Dresser, professor of law and medical ethics at Washington University in Missouri, said that designating a health care proxy is the best of a bad set of choices.
"Having someone you trust, maybe a couple of people, at the bedside who know you and can deal with the up-to-date situation, it's not ideal," Dresser said. "Ideally, we'd have the patient tell us, but since we often can't have that, then that's probably the next best alternative that's workable."
Bill Colby at the Center for Practical Bioethics writes about the Center's goals for improving end-of-life discussions.
I interviewed Missouri legislators in the 1980s as potential trial witnesses for the Nancy Cruzan case. Those legislators thought that when they passed the 1985 Missouri living will law, they were “solving” cases like Nancy’s. Lawmakers who passed the 1990 federal Patient Self-Determination Act thought the same thing.
But laws by their very nature have limits. I think the focus of the AMN article is right. We need to simplify the “legal part” at the end-of-life. And we need to urge people to do a much better job of talking to one another.
We will be digging for some creative solutions at this Center to do just that in the months ahead. Stay tuned.
The Health Beat blog's Maggie Mahar also writes about the AMNews article.
