A Prospective Study of Advance Directives for Life-Sustaining Care
New England Journal of Medicine. 1991 Mar 21; 324(13): 882-888.
To evaluate the effectiveness of advance directives, the authors conducted a prospective study over a two-year period in a nursing home. A group of 126 competent residents and 49 family members of incompetent residents were interviewed to determine their preferences with respect to hospitalization, intensive care, resuscitation, artificial ventilation, surgery, and artificial feeding in the event of critical illness, terminal illness, or permanent unconsciousness. Advance directives were placed in the medical records to assist in nursing home care and to be transferred to the hospital with the patient if necessary. In 96 cases of hospitalization or death in the nursing home, care was consistent with the advance directive 75% of the time. The presence of an advance directive in the medical record did not facilitate consistency. The directive's effectiveness could be limited by inattentiveness or by decisions to place priority on considerations other than patient autonomy. (KIE abstract)
Advance Directives; Aged; Allowing to Die; Artificial Feeding; Attitudes; Autonomy; Critically Ill; Death; Decision Making; Evaluation; Evaluation Studies; Family Members; Home Care; Hospitals; Institutional Policies; Intensive Care Units; Illness; Life; Medical Records; Nursing Homes; Patient Care; Patient Transfer; Patients; Persistent Vegetative State; Policy Analysis; Prolongation of Life; Records; Resuscitation; Resuscitation Orders; Surgery; Survey; Terminal Care; Terminally Ill; Unconsciousness; Ventilators; Withholding Treatment;
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