Decisions on end-of-life care shouldn't be left to the end

Advance directives should evolve after a series of discussions between physician and patient.

By Susan J. Landers, AMNews staff. Sept. 2, 2002.

Washington -- Knowing in advance the type of medical care they will receive at life's end is often a huge relief, not only to patients and their families, but also to their physicians.

Should a physician pull out all the stops for a terminally ill patient? Is CPR something the patient would expect? How about a feeding tube?

What would your basically healthy elderly patient want? Whose standards do you use when defining quality of life? The patient's? A family member's? The physician's?

There has been a push in recent years to encourage all patients to talk with their physicians and families about advance care planning so they can participate, through a health care proxy if necessary, in decisions that will need to be made at the end of life.

There is no question that advance care planning is important, even if most people would rather not think about it. Quoting a British friend, Richard Roberts, MD, board chair of the American Academy of Family Physicians, said, only half jokingly, "One problem Americans have is 'we think of death as an option.' "

An advance directive can also be of great comfort to a physician, said Dr. Roberts. "What it does is give the doctor something that makes him or her feel more comfortable not doing everything."

Advance directives can provide legal backup in case a physician is second-guessed and sued by surviving family members, he added.

The complex issues surrounding end-of-life care led Ferdinando L. Mirarchi, DO, an emergency physician at Hamot Medical Center in Erie, Pa., to write the book, What's the Patient's Code Status? The need for answers arose when Dr. Mirarchi's elderly grandmother was very ill and his mother didn't know what should be done. He gathered material for his mother and realized that it might be useful to others as well. [...]