Lost in Translation: The Unintended Consequences of Advance Directive Law on Clinical Care

Abstract

Background-Advance directive law may compromise the clinical effectiveness of advance directives.

Preferences for Resuscitation and Intubation Among Patients With Do-Not-Resuscitate/Do-Not-Intubate Orders

“…As others have noted, linguistic and cognitive factors are important barriers to clear code status discussions. 34 Our study did not assess the contribution of these factors, rendering our conclusions regarding the prevalence of discrepancies conservative. Further studies are needed to inform strategies for improved communication in discussion of life-sustaining treatments.…”

“…The diversity of our patient population was limited. Future studies (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) should assess potential associations between code status and preference discrepancies and race/ethnicity. Previous investigators' work suggests that patient preferences depend heavily on how scenarios are described to patients.…”

Directives anticipées

“…Ils souhaitent cependant que le médecin aborde luimême la question des DA [94], probablement par manque de connaissance du sujet et des enjeux [79,34]. Les DA demeurent également très dépendantes du contexte culturel et social [95]. En Europe du sud, par exemple, on note peu de DA, peu de LAT, une information limitée sur le pronostic en comparaison de l'Europe du nord [96].…”

“…Se pose également la question des ressources financières néces-saires (notaire) pour officialiser les DA dans certains cas (power of attorney aux États-Unis, mandat de protection future notarié, en France) et le niveau d'éducation qui constitue une barrière reconnue à leur élaboration, notamment au sein des minorités peu scolarisées [103][104][105]. Les textes régissant les DA étant du niveau de classe terminale [95]. Dix pour cent des formulaires de DA correspondent à un niveau de lecture équivalent ou plus simple que celui du lecteur américain moyen [106].…”

When It’s Your Time, Will It Be Your Way?

“…8 Other plausible explanations include not perceiving its necessity due to youth, current good health, or unease in pondering one's mortality and unintended legal and procedural consequences that may pose barriers to understanding or completing these documents. 9 As discomforting as it may be to plan for our own demise, that effort affords us the greatest possibility for ensuring that time is consistent with our deepest wishes. None of us knows when we might need to deal with such unwelcome news, so my suggestion is to thoughtfully consider what would be most important to you at the end of your life and summarize what you want so it can be discussed and shared with those most likely to carry out your wishes.…”