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Catalysts for Conversations About Advance Directives: The Influence of Physician And Patient Characteristics

Published online by Cambridge University Press:  01 January 2021

Jeremy Sugarman ,
Nancy E. Kass ,
Ruth R. Faden  and
Steven N. Goodman
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Extract

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.

Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome (AIDS), those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 22 , Issue 1 , Spring 1994 , pp. 29 - 35
Copyright
Copyright © American Society of Law, Medicine and Ethics 1994

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References

The Patient Self-Determination Act (Pub. L. No. 101–508, § 4206 and § 4751) requires that all patients be asked whether they have an advance directive on admission to a Medicare-funded health care facility and be informed about their rights to formulate advance directives pursuant to state law.Google Scholar
Emanuel, Linda L., Barry, Michael J., Stoeckle, John D., Ettlelson, Lucy M., Emanuel, Ezekiel J., “Advance Directives for Medical Care—A Case for Greater Use,” N. Engl. J. Med., 324, no. 13 (1991): 889–95.CrossRefGoogle Scholar
Clark, Jack A., Potter, Deborah A., McKinlay, John B., “Bringing Social Structure Back into Clinical Decision Making,” Soc. Sci. Med., 32, no. 8 (1991): 853–66.CrossRefGoogle Scholar
Haas, Jennifer S., Weissman, Joel S., Geary, Paul D. et al., “Discussions of Preferences for Life-Sustaining Care by Persons with AIDS: Predictors of Failure in Patient-Physician Communication,” Arch. Intern. Med., 153, no. 10 (1993): 1241–48.CrossRefGoogle Scholar
Teno, Joan, Fleishman, John, Brock, Dan W., Mor, Vincent, “The Use of Formal Prior Directives among Patients with HIV-Related Diseases,” J. Gen. Intern. Med., 5 (Nov./Dec. 1990): 490–94.CrossRefGoogle Scholar
Wachter, Robert M., Luce, John M., Hearst, Norman, Lo, Bernard, “Decisions about Resuscitation: Inequities among Patients with Different Diseases but Similar Prognoses,” Ann. Intern. Med., 111, no. 6 (1989): 525–32.CrossRefGoogle Scholar
American Medical Directory, 32nd ed. (Chicago: American Medical Association, Division of Survey and Data Resources, 1990); Directory of Medical Specialists, 25th ed. (Wilmette, IL: Marquis Who’s Who, Macmillan Directory Division, 1991-92); and The Official American Board of Medical Specialties (ABMS) Directory of Board Certified Medical Specialists, 4th ed. (Evanston, IL: American Board of Medical Specialties, 1992-93).Google Scholar
See Wachter, et al., supra note 6.Google Scholar
Steinbrook, Robert, Lo, Bernard, Moulton, Jeffrey, Saika, Glenn, Hollander, Harry, Volberding, Paul A., “Preferences of Homosexual Men with AIDS for Life-Sustaining Treatment,” N. Engl. J. Med., 314, no. 7 (1986): 457–60.CrossRefGoogle Scholar
See Wachter, et al., supra note 6.Google Scholar
Davidson, Kent W., Hackler, Chris, Caradine, Delbra R., McCord, Ronald S., “Physicians' Attitudes on Advance Directives,” JAMA, 262, no. 17 (1989): 2415–19.CrossRefGoogle Scholar
See Haas, et al., supra note 4; and Teno, et al., supra note 5.Google Scholar
Hayward, Rodney A., Weissfeld, Joel L., “Coming to Terms with the Era of AIDS: Attitudes of Physicians in US Residency Programs,” J. Gen. Intern. Med., 8 (Jan. 1993): 10–18; and Kelly, Jeffrey A., St. Lawrence, Janet S., Smith, Steve, Hood, Harold V., Cook, Donna J., “Stigmatization of AIDS Patients by Physicians,” Am. J. Public Health, 77, no. 7 (1987): 789-91.CrossRefGoogle Scholar
Sherwin, Susan, No Longer Patient: Feminist Ethics and Health Care (Philadelphia: Temple University Press, 1992).Google Scholar
See Emanuel, et al., supra note 2.Google Scholar
Sachs, Greg A., Stocking, Carol B., Miles, Steven H., “Empowerment of the Older Patient? A Randomized, Controlled Trial to Increase Discussion and Use of Advance Directives,” J. Am. Geriatrics Soc., 40, no. 3 (1992): 269–73.CrossRefGoogle Scholar
See Teno, et al., supra note 5.Google Scholar
See Haas, et al., supra note 4; and Steinbrook, et al., supra note 9.Google Scholar