Findings support value of advance directives, living wills and other means of making end-of-life treatment preferences known

One in four elderly Americans require someone else to make decisions about their medical care at the end of their lives, according to a new study in the New England Journal of Medicine.

"The results illustrate the value of people making their wishes known in a living will and designating someone to make treatment decisions for them, the researchers said," The Associated Press reports. "In the study, those who spelled out their preferences in living wills usually got the treatment they wanted. Only a few wanted heroic measures to prolong their lives. The researchers said it's the first accounting of how many of the elderly really end up needing medical decisions made for them." The issue of end-of-life care came up in the health care debate, when "[a] provision in the legislation would have allowed Medicare to pay doctors for counseling patients about end-of-life issues like living wills. Critics labeled the counseling 'death panels' and the proposal was eventually dropped before the researchers could get their report out. They had pushed to complete the study because of the national debate, but it took time to get it published, said the study's leader, Dr. Maria Silveira" (Nano, 3/31).

Los Angeles Times: "Silveira used data from the long-running Health and Retirement Study, which surveys adults ages 51 and older nationwide. In analyzing data from people ages 60 and older who died between 2000 and 2006, researchers found that of the 398 incapacitated people who had used a living will to request limited care at the end of life, almost 83% received it… An editorial accompanying the study says that other researchers have found advance directives to be of limited value. "What we really would like to know -- whether the preferences of patients were any more likely to be honored if they had a living will than if they did not -- cannot be determined from this study," said the author of the commentary, Dr. Muriel R. Gillick, a specialist in end-of-life care at Harvard Medical School's Department of Population Medicine" (Roan, 3/31).

BusinessWeek: "Silveira said that whenever someone enters a hospital or care facility, he or she is given the opportunity to complete an advance directive, which is one reason why so many elderly people may have these documents. The problem, however, is that many people will designate a health-care proxy or prepare a living will and then tuck the document away without discussing it" (Gordon, 3/31).

Medpage Today: "Just last week researchers reported on a randomized trial of a comprehensive, hospital-based effort to improve advanced planning for end-of-life care in elderly patients. It likewise found that planning improved the likelihood that a patient's wishes would be followed and reduced emotional trauma among family members. Together, the results add weight to the movement for advance planning in end-of-life care and decision-making." But Muriel R. Gillick, MD, of Harvard and the Harvard Pilgrim Health Care Institute in Boston wrote in an editorial accompany the NEJM study that the results of the study "are insufficiently compelling to reverse the code status of legalistic advance-directive documents" (Phend, 3/31).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.