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Medical Ethics

But are advance directives effective in achieving the aim intended?.
             There is evidence to indicate that advance directives alone fall far short of their objective. 66% of all physicians interviewed felt there was nothing wrong with overriding a patient's advance directive, even if the directive unambiguously stated the conditions for the withdraw and withholding of medical treatment. Also a reported 40% of the physicians questioned chose a level of care different from that requested in advance by patients who subsequently became incompetent. The physicians interviewed indicated that they would only follow a patient's advance directive if it were consistent with their own clinical judgment. The physicians indicated that they wanted to reserve the right to make clinical judgments about treatment regardless of a patient's request. In very few cases did advance directives have any influence over decisions to withdraw or withhold life-prolonging treatment. When patients were transferred from ambulatory to acute care settings, only 26 percent of the patients who had advance directives had them recognized by the admitting hospital. .
             These situations command our attention. They also make us focus on the tension and disagreement that exists between physicians and their patients. The population clearly seeks more control over both their future medical care and also the method, timing, and place of their death. Patients want issurance that there will be no unreasonable efforts, an affirmation that the dignity to be sought in death is the appreciation by others of what one has been in life. The acceptance of one's own death is a necessary process of nature. Yet these statistics show that physicians often do not allow patient control. How disheartening for a patient to fear that the doctor cannot be trusted in a matter of such importance. It appears that many doctors have no respect for their patients" wishes.


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