Patient, Physician, and Family Member Understanding of Living Wills

Abstract

This study examines understanding of living wills by patients, family members, and physicians. Questionnaires were used to examine whether each cohort understood patients' living wills regarding endotracheal intubation and cardiopulmonary rescuscitation (CPR). Of 4,800 patients admitted during the study period, 206 reported having living wills, all of which precluded intubation and CPR for "terminal conditions." Of 140 admitted to the general hospital wards, 17 (12%) wanted their living wills to preclude intubation/mechanical ventilation and 12 (8.6%) did not want resuscitation under any circumstances. Seven of 120 (6%) physicians and 4 of 108 family members would not intubate or perform CPR even if there was a chance of recovery. Of 88 patients with complete data (including physicians and family members), 29 (33%) wanted their living wills to block intubation/mechanical ventilation only if they were deemed terminal and 46 (52%) wanted the living will to block intubation even if there was a 10% chance of recovery. Thirteen (15%) wanted to block intubation even if the chance of recovery was > or = 50. Results were similar for wishes regarding CPR. These data suggest substantial differences of patient, physician, and family member understanding of living wills. Living wills did not reflect fully patients' expectations of receiving (or not receiving) life-sustaining modalities.

Advance Directives in an Oncologic Intensive Care Unit: A Contemporary Analysis of their Frequency, Type, and Impact

“…1,4,37,38 Achieving this consensus is challenging, because a universal perception of hopelessness does not exist, and the concept of an ''abbreviated'' ICU trial (5-7 days) for critically ill patients with cancer is just entering the CCM lexicon. 17 Concomitantly, proxies do not have much faith in physicians' prognostication abilities 29,30,39,40 and may disagree among themselves or with their physicians even when faced with irrefutable evidence that death is imminent. 41,42 Finally, there is no legal accountability if a LW is ignored.…”

Is there a role for physician involvement in introducing research to surrogate decision makers in the intensive care unit? (The Approach trial: a pilot mixed methods study)

“…At the time they are approached to consider research participation, SDMs and family members may not know the patient's values and preferences [2] and may hold personal views regarding research that differ from the patient's [3]. A study involving hypothetical scenarios found that ICU survivors preferred consent for their research participation to be obtained from SDMs [4].…”

TRIAD II: Do Living Wills Have an Impact on Pre-Hospital Lifesaving Care?

“…It not only affects health care personnel but the lay public as well. Patients and families are often under the impression that a living will is to be utilized to preclude treatment regardless of reason or cause (14). However, confusion surrounding DNR is not a provincial phenomenon and has afflicted health care for two decades, as first reported by Eisendrath and Jonsen (1983) (15).…”