Tuesday, June 10, 2008

Don't Just "Talk", "Walk" Care Directives

On May 14, 2008, the American Bar Association released results of a survey about the use of advance health care planning documents, in a Press Release entitled "ABA-Commissioned Poll Finds More than Twice as Many Americans Talk About Planning For Healthcare Emergencies than Take Action".

More than three-quarters of Americans "talk the talk" about health care decision making, but less than one-third "walk the walk" by appointing someone in a health care directive.

A Health Care Directive, a/k/a Advance Directive, and sometimes referenced generically as a Living Will, is a signed document expressing a person’s treatment preferences or naming an individual to act as a surrogate that becomes effective when that person becomes unable to make health care decisions, even end-of-life determinations, effectively.

According to the ABA in its Online Media Kit on the "Right to Die",
health care and end-of-life advance planning can accomplish four things:

  • Ensures that the person you want to speak for you has the legal authority to do so
  • Helps ensure that your wishes about your health care are known and respected
  • Avoids unnecessary, intrusive, and costly medical treatment at the point you not longer want it
  • Reduces the suffering experienced by your loved ones, because they will have your guidance. Making serious medical decision on a loved one’s behalf without their guidance is an agonizing experience
The Press Release summarized key findings of the poll, which was conducted by Harris Interactive on behalf of the ABA between April 9-11, 2008, among 2,092 U.S. residents aged 18 and older:
  • Older Americans, those living in the south and those with annual incomes of at least $50,000 are more likely than other people to have discussed how they want to be cared for if they are unable to make their own health care decisions.
  • Barely half of single, never-married adults have discussed their health care wishes.
  • The group least likely to discuss their wishes for care if they become incapacitated are men aged 18 to 34. And yet, according to 2005 information from the Centers for Disease Control, young men aged 15 to 24 have three times as many deaths as do women in the same age group and in the 20 to 29 age group, men have twice as many deaths as similarly aged women, indicating that young men are a group in need of advance directives.
  • Education level makes little difference in whether or not a person has an advance directive as 30 percent of those with a high school education or less have made their wishes known compared to 28 percent of those with some college and 34 percent of those who have at least a bachelor’s degree.
For whatever reason provided by the respondents as to why no HCD directive exists for them, the message, reinforced by the survey results, is clear, according to the Press Release:
Advance planning for healthcare decisions is something none of us can afford to ignore,” said American Bar Association President William H. Neukom. “It’s tempting to feel invulnerable when we are young, but statistics make a powerful case for advance planning.

“Making healthcare decisions offers people peace of mind and limits the potential for discord among families,” Neukom added.

“The ABA supports advance planning so people can consider their decisions thoughtfully rather than feel pressured to decide on behalf of a loved one or family member in the emotional aftermath of an accident or sudden illness.”
This message was reinforced on April 15, 2008, in an opinion-editorial article issued in anticipation of the first National Healthcare Decisions Day on April 16, 2008, co-authored by Ronald M. Davis, President, American Medical Association, and William H. Neukom, President, American Bar Association, entitled "Op-Ed: Health Care Advance Planning - The Discussion That Can't Wait".

The ABA provides, on its website, basic information regarding health care directives, including:
Generally, however, the governing law is state-enacted, and therefore state-specific. For more information about HCDs in Pennsylvania, see this Blog's topic "Healthcare Directives" or the PA HEALTHCARE DECISIONMAKING website.