Can't We Improve on Advance Directives?
Authors: Gerlyn M. Brasic, Bernard J. Hammes
Journal: Annals of Internal Medicine (2008)

Letters4 March 2008Can't We Improve on Advance Directives?Gerlyn M. Brasic, MD and Bernard J. Hammes,Gerlyn M. Brasic, MDFrom Gundersen Lutheran Medical Center, La Crosse, WI 54601.Search for more papers by this author and Bernard J. Hammes,From Gundersen Lutheran Medical Center, La Crosse, WI 54601.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-5-200803040-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:“Every system is perfectly designed to produce the outcomes it achieves.” The article by Perkins (1) underscores this point. Whereas many patients believe that completing an advance directive improves the chance that their choices will be respected (2), the tragic events of this story demonstrate that health systems are often unprepared to recognize and honor a patient's preferences even when they are specifically stated.The failure in the story of Mr. Jones is not because of a flawed advance directive but because the primary physician did not establish a support structure, such as hospice, to keep Mr. ...References1. Perkins HS. Controlling death: the false promise of advance directives. Ann Intern Med. 2007;147:51-7. [PMID: 17606961] LinkGoogle Scholar2. Perkins HS, Cortez JD, Hazuda HP. Advance care planning: does patient gender make a difference? Am J Med Sci. 2004;327:25-32. [PMID: 14722393] CrossrefMedlineGoogle Scholar3. Citizens Healthcare Working Group. Health care that works for all Americans. Health report to the American people. Accessed at www.citizenshealthcare.gov on 24 January 2008. Google Scholar4. Hammes BJ, Rooney BL. Death and end-of-life planning in one midwestern community. Arch Intern Med. 1998;158:383-90. [PMID: 9487236] CrossrefMedlineGoogle Scholar5. Tolle SW, Tilden VP, Nelson CA, Dunn PM. A prospective study of the efficacy of the physician order form for life-sustaining treatment. J Am Geriatr Soc. 1998;46:1097-102. [PMID: 9736102] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Gundersen Lutheran Medical Center, La Crosse, WI 54601.Disclosures: Gundersen Lutheran Medical Foundation sponsors the Respecting Choices program, and Dr. Hammes receives a portion of his salary for work in that program. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoControlling Death: The False Promise of Advance Directives Henry S. Perkins Can't We Improve on Advance Directives? Henry S. Perkins Can't We Improve on Advance Directives? Kenneth J. Simcic Can't We Improve on Advance Directives? Frank Carter Metrics 4 March 2008Volume 148, Issue 5Page: 405-406KeywordsAdvanced directivesConflicts of interestDyspneaEnd of life careHealth careHealth care qualityPalliative careQuality of lifeSurgeonsSurgery ePublished: 4 March 2008 Issue Published: 4 March 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...