Can't We Improve on Advance Directives?

Field: Health Professions (Health Sciences)

Letters4 March 2008Can't We Improve on Advance Directives?Henry S. Perkins, MDHenry S. Perkins, MDFrom the University of Texas Health Science Center at San Antonio, San Antonio, TX 78229.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-5-200803040-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:These letters represent a wide range of views about the usefulness of advance directives. Dr. Simcic's skepticism is similar to mine. Dr. Carter gives advance directives modest support, using them for now but hoping for better approaches in the future. Drs. Brasic and Hammes believe strongly that the current system of advance directives prevents overly aggressive treatment of dying patients, saves resources, and promotes comfort.The view of Drs. Brasic and Hammes, whose end-of-life work I admire, differs most from my own. I believe their enthusiasm for advance directives rests on 2 faulty assumptions. The first is that ...References1. The SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. JAMA. 1995;274:1591-8. [PMID: 7474243] CrossrefMedlineGoogle Scholar2. Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM. Patterns of functional decline at the end of life. JAMA. 2003;289:2387-92. [PMID: 12746362] CrossrefMedlineGoogle Scholar3. Perkins HS, Geppert CM, Gonzales A, Cortez JD, Hazuda HP. Cross-cultural similarities and differences in attitudes about advance care planning. J Gen Intern Med. 2002;17:48-57. [PMID: 11903775] CrossrefMedlineGoogle Scholar4. Uhlmann RF, Pearlman RA, Cain KC. Physicians' and spouses' predictions of elderly patients' resuscitation preferences. J Gerontol. 1988;43:M115-21. [PMID: 3418031] CrossrefMedlineGoogle Scholar5. Perkins HS. Time to move advance care planning beyond advance directives [Editorial]. Chest. 2000;117:1228-31. [PMID: 10807804] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Henry S. Perkins, MDAffiliations: From the University of Texas Health Science Center at San Antonio, San Antonio, TX 78229.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoControlling Death: The False Promise of Advance Directives Henry S. Perkins Can't We Improve on Advance Directives? Kenneth J. Simcic Can't We Improve on Advance Directives? Frank Carter Can't We Improve on Advance Directives? Gerlyn M. Brasic and Bernard J. Hammes Metrics Cited byUse of conditional medical orders to minimize moral, ethical, and legal risk in critical care 4 March 2008Volume 148, Issue 5Page: 406KeywordsDo not resuscitate ordersElderlyForecastingFrailtyHand strengthHealth careHeart diseasesHeart failurePatient advocacyPatients ePublished: 4 March 2008 Issue Published: 4 March 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...