National Health Care Decisions Day is April 16th! For 2017 it will be a week-long event from April 16th – 22nd. In honor we will be posting daily information on Advance Directives.
Since 1985, the Colorado General Assembly has authorized several methods for individuals to document advance medical directives and/or appoint surrogate healthcare decision makers.
- Colorado Directive as to Medical Treatment (aka “living will,”)
- CPR Directive
- Medical Durable Power of Attorney for Healthcare
- Healthcare Proxy process (see Appendix A for details)
The first two – the living will and CPR Directive – document refusals of certain life-support treatments under certain circumstances; the second two provide mechanisms by which legal representatives or surrogates may be identified for the purpose of healthcare decision making. (For more information on these advance directives and appropriate forms, please refer to Your Right to Make Health Care Decisions [CHA, 2012]). All four tools are empowered by the well-established, in law and medical practice, right of a competent adult to refuse any medical treatment at any time for any reason, even if the result is death.
The Federal Patient Self-Determination Act of 1990 requires any healthcare facility receiving federal funds to ask patients whether they have advance directives and to provide information on the available options, if desired. Despite this requirement, and more than two decades of vigorous efforts to educate the public about their rights and responsibilities with respect to advance medical treatment decision making, it is estimated that only about 18 to 30 percent of Americans generally and only about 1 in 3 chronically ill individuals have executed advance directives. Among the critically or terminally ill, the rate does not exceed 1 in 2 (USDHHS, 2007). Furthermore, even when advance directives are completed, barriers and stumbling blocks can impede their use.
There are numerous explanations for the “failure” of advance directives, but some of the most often cited include:
- Opportunities for discussion of possible treatment preferences and documentation of decisions are limited by systemic gaps or constraints and personal issues.
- Documented treatment preferences/decisions are unclear, not specific, or not relevant to the individual’s current health status.
- Documents – or surrogates – are not available at the time they are needed.
- Documents are incomplete, in a form that is not familiar to the healthcare professional or setting, or otherwise do not conform to legal or standard practice requirements. (USDHHS, 2007)
Some intensively collaborative educational efforts focused on particular communities have achieved completion and adherence rates well above 70 percent (e.g., LaCrosse, WI [Hammes & Rooney, 1998]; Oklahoma [McAuley, 2008]). Other interventions have focused on particular factors, such as enhanced training of healthcare and social service professionals, community education, introducing setting-specific systems (e.g., automatic completion of ADs on nursing home admission), and improving particular documentation tools.