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Correspondence |

When Patients and Surrogates Disagree About Advance Directives FREE TO VIEW

Peter Terry, MD, FCCP
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

CORRESPONDENCE TO: Peter Terry, MD, FCCP, The Johns Hopkins Hospital, 1830 Building 5th Floor, 1830 E Monument St, Baltimore, MD 21205


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(6):1576-1577. doi:10.1016/j.chest.2016.02.678
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In a recent issue of CHEST (February 2016), Bruce et al describe decision-making when surrogates disagree with an advance directive and then lay out four considerations for overriding an advance directive. The authors may be comforted to know that there is empiric evidence showing that most patients would welcome having their advance directive ignored. In a study of 300 terminally ill patients who were asked whether they would want their advance directive followed should a loved one object, 54% said they would want their advance directive ignored. Reasons given were that surrogates made better decisions, or the patients were concerned that the surrogates’ best interest be paramount.

Preventive ethics approaches may minimize these conflicts. The first being a statement at the end of an advance directive, such as “Would you want us to ignore your living will if your loved one disagrees with it?” Also, in the usual circumstance where a physician or lawyer asks a patient what care s/he would want at the end of life, the patient presumes that s/he must make these decisions, yet there is much empiric evidence that the majority of patients do not want to make decisions by themselves. We should first be asking patients who they would want to be involved in the decision-making process. This approach would likely lead to fewer disagreements because the loved ones or physicians most likely to disagree would already be involved in the decision-making process before the time when a difficult end-of-life decision had to be made.

References

Bruce C.R. .Bibler T. .Childress A.M. .Stephens A.L. .Pena A.M. .Allen N.G. . Navigating ethical conflicts between advance directives and surrogate decision-makers’ interpretations of patient wishes. Chest. 2016;149:562-567 [PubMed]journal. [CrossRef] [PubMed]
 
Terry P.B. .Vettese M. .Song J. .et al End-of-life decision making: when patients and surrogates disagree. J Clin Ethics. 1999;10:286-293 [PubMed]journal. [PubMed]
 

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References

Bruce C.R. .Bibler T. .Childress A.M. .Stephens A.L. .Pena A.M. .Allen N.G. . Navigating ethical conflicts between advance directives and surrogate decision-makers’ interpretations of patient wishes. Chest. 2016;149:562-567 [PubMed]journal. [CrossRef] [PubMed]
 
Terry P.B. .Vettese M. .Song J. .et al End-of-life decision making: when patients and surrogates disagree. J Clin Ethics. 1999;10:286-293 [PubMed]journal. [PubMed]
 
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