What do Doctors Know That We Don’t?
A controversial article written by retired physician Ken Murray entitled "How Doctors Die" has people talking about advance directives – also known as Living Wills.
Advance directives are legal documents which express a person’s wishes with respect to the kind of health care they want to receive in the event they become unable to make medical decisions for themsleves. Legislation in Ontario requires that advance directives be considered when others make health care decisions on your behalf.
Pursuant to section 21(2) of the Health Care Consent Act:
"A person who gives or refuses consent to a treatment on an incapable person’s behalf shall do so inaccordance with the following principles:
1. If the person knows of a wish applicable to the circumstances that the incapable person expressed while capable and after attaining 16 years of age, the person shall give or refuse consent in accordance with the wish.
2. If the person does not know of a wish applicable to the circumstances that the incapable person expressed while capable and after attaining 16 years of age, or if it is impossible to comply with the wish, the person shall act in the incapable person’s best interests."
A recent study found that about 67% of physicians prepare advance directives – while less than half of lay severly or termanilly-ill patients do. Those who did prepare advance directives were three and a half times more likely to refuse certain types of medical intervention, including "rescue care" such as CPR.
Ken Murray’s article highlights the irony of a system where most physicians make the personal choice to refuse the very same procedures they perform on patients everyday. In his article, he suggests that physicians are adverse to "futile care" because they know from experience that such procedures often merely prolong and exacerbate suffering, especially when performed on unhealthy elderly and/or chronically ill patients.
So, whether your instructions are to avoid so-called heroic measures, or to encourage the use of any means possible to elongate your life, advance directives are an excellent way to clarify your views with respect to your health care plan. They also assist your substitute-decision maker in making difficult choices consistent with your wishes.
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