CASWELL BELL & HILLISON LLP
FRESNO, CALIFORNIA

THINKING ABOUT ADVANCE HEALTH CARE DIRECTIVES

After the Terri Schiavo case, many persons opined on the necessity of an advanced health care directive.  A health care directive is a document that provides, among other things, instructions to medical personnel regarding the wishes of the person as to end-of-life decisions.

Yet, a growing body of scholarly literature that questions the importance of advanced health care directives.  Consider the level of personal reflection needed to make an “informed” decision.  A person facing a potentially terminal condition would need substantial information in order to make an informed end-of-life decision, just for one factual situation.

How Much Information is Needed?

The scholarly literature suggests that it is impossible for a healthy person to be able to analyze all of the potential health conditions that could arise in the future, and to decide, in advance, how he or she would want to be treated in each of those circumstances.

Even more, this is not truly a legal question:  it is a question for the individual to discuss with his or her treating physician.  Perhaps the advanced health care directive form should be completed by the patient with her doctor, not by the client with her attorney.  That makes a lot of sense.

Doctors Make Their Own Decisions

Research also indicates that doctors do not always follow the instructions given in an advanced health care directive.  For example, In a 2004 study, almost two out of three doctors, when presented with hypothetical cases, did not follow their patients’ advanced health care directives. 

In the study at Loma Linda University School of Medicine, 117 resident physicians and medical school faculty were asked in surveys how they would respond to six hypothetical cases involving end-of-life decisions.  The results were published in the July 26, 2004 issue of the Archives of Internal Medicine. 

In each case, the patients’ wishes conflicted with what the patient’s family wanted, or conflicted with the patient’s likelihood-of-survival or quality-of-life factors.  Confronted with difficult choices, the medical school professors made medical decisions that conflicted with the patients’ directives 68% of the time, while the residents’ decisions were at variance with the patients’ wishes 61% of the time. 

Admittedly, the survey can be challenged on the grounds that the sample size was small, and the survey was taken based on hypothetical cases, not based on actual real-life scenarios.

Still, the survey is consistent with previous research indicating that advance health care directives are not necessarily treated as controlling by medical professionals.  Thus, it seems that the advanced health care directive is not a one-size-fits-all solution, but is instead a powerful document that should be considered separately by each person, with input from his or her doctor.

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