Advance Healthcare Directives
T. S. Dharmarajan, MD
Vice Chairman, Department of Medicine (North Division)
Clinical Director, Division of Geriatrics (North Division)
Legislated in 1991 with the Patient Self-Determination Act (PSDA) to strengthen patients' rights to be involved in treatment decisions at the end of life, advance health care directives (living wills, powers of attorney, and health care proxies) specify an individual's desired healthcare-related actions in the event that they can no longer make decisions due to illness or incapacity.
Despite legal, ethical, and societal support for patients to take an active role in end-of-life decisions, studies show that only a small percentage of patients--and an even smaller percentage of minority patients--have advance directives.
A recent residency program study conducted at Montefiore North Division examined the current state of and issues associated with improvement in patient compliance with having and/or signing an advance directive. In this study, residency trainees collected data from over 1700 individuals to determine if newly admitted Medicine inpatients had existing advance directives. A sub-set of these individuals were interviewed, explained the purpose of, and asked to consider signing an advanced directive.
The study found that 35% of the Bronx residents interviewed had an advance directive (national average <33%). Age, sex, marital status, race, health perception, recent hospitalizations, and personal (religious) beliefs did not influence having or signing an advance directive. Patients with increasing comorbidities, a preferred doctor, and/or more schooling were more likely to have or to express interest in signing an advance directive.
The Montefiore North Advance Directives abstract was sought by the American College of Physicians for the ethics section of its website.