Advance Directives: Time To Move On
Authors: Joan M. Teno
Journal: Annals of Internal Medicine (2004)

Editorials20 July 2004Advance Directives: Time To Move OnJoan M. Teno, MD, MSJoan M. Teno, MD, MSFrom Brown University Medical School, Providence, RI 02912.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-2-200407200-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail There is always an easy solution to every human problem—neat, plausible, and wrong.–H.L. Mencken (1)For the past 2 decades, people have debated the role of advance directives in decision making and improving end-of-life care in the United States (2-4). From a normative standpoint, advance directives are an important legal tool for persons to state preferences and name a surrogate decision maker in case they became mentally incapacitated later in life. However, empirical research findings raise questions about the role of written advance directives because of doubts about the stability of patient preferences (5), how living wills are used in ...References1. Mencken HL. The divine afflatus. New York Evening Mail. 16 November 1917. Google Scholar2. Lynn J. Why I don't have a living will. Law Med Health Care. 1991;19:101-4. [PMID: 1895759] CrossrefMedlineGoogle Scholar3. Teno J, Lynn J, Wenger N, Phillips RS, Murphy DP, Connors AF, et al . Advance directives for seriously ill hospitalized patients: effectiveness with the patient self-determination act and the SUPPORT intervention. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc. 1997;45:500-7. [PMID: 9100721] CrossrefMedlineGoogle Scholar4. Fins JJ. Advance directives and SUPPORT [Editorial]. J Am Geriatr Soc. 1997;45:519-20. [PMID: 9100724] CrossrefMedlineGoogle Scholar5. Ditto PH, Smucker WD, Danks JH, Jacobson JA, Houts RM, Fagerlin A, et al . Stability of older adults' preferences for life-sustaining medical treatment. Health Psychol. 2003;22:605-15. [PMID: 14640858] CrossrefMedlineGoogle Scholar6. Teno JM, Licks S, Lynn J, Wenger N, Connors AF, Phillips RS, et al . Do advance directives provide instructions that direct care? SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc. 1997;45:508-12. [PMID: 9100722] CrossrefMedlineGoogle Scholar7. Teno J, Lynn J, Connors AF, Wenger N, Phillips RS, Alzola C, et al . The illusion of end-of-life resource savings with advance directives. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc. 1997;45:513-8. [PMID: 9100723] CrossrefMedlineGoogle Scholar8. Molloy DW, Guyatt GH, Russo R, Goeree R, O'Brien BJ, Bédard M, et al . Systematic implementation of an advance directive program in nursing homes: a randomized, controlled trial. JAMA. 2000;283:1437-44. [PMID: 10732933] CrossrefMedlineGoogle Scholar9. Degenholtz HB, Rhee Y, Arnold RM. Brief communication: the relationship between having a living will and dying in place. Ann Intern Med. 2004;141:113-7. LinkGoogle Scholar10. Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Shield R, et al . Family perspectives on end-of-life care at the last place of care. JAMA. 2004;291:88-93. [PMID: 14709580] CrossrefMedlineGoogle Scholar11. Facts On Dying: Policy Relevant Data on Care at the End of Life. Background Information to Aid in Understanding the Study of Care at the Last Place of Care. Providence, RI: Center for Gerontology and Health Care Research, Brown Medical School; 2000. Accessed at www.chcr.brown.edu/dying/physicalcomfort.htm on 2 June 2004. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Brown University Medical School, Providence, RI 02912.Grant Support: By the Robert Wood Johnson Foundation (grant 027188).Disclosures:Grants received: Robert Wood Johnson Foundation.Corresponding Author: Joan M. Teno, MD, MS, Center for Gerontology and Health Care Research, Brown University, 2 Stimson Avenue, Providence, RI 02912; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBrief Communication: The Relationship between Having a Living Will and Dying in Place Howard B. Degenholtz , YongJoo Rhee , and Robert M. 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