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Talking, Advance Directives, and Medical Practice

Talking, Advance Directives, and Medical Practice Abstract THREE ARTICLES in the current issue of the Archives analyze the willingness of physicians to talk to their patients about end-of-life concerns. One of these articles1 also studies the patient's desire for such a conversation. Not surprisingly, many physicians continue to be unwilling to talk to their patients about such matters despite the fact that most patients (as well as the physicians themselves when they see themselves as patients) would want to participate in such discussions.1-3 In the study by Markson et al,3 an educational intervention of both didactic material and practical experience is employed to facilitate the use of advance directives (ADs) by physicians. An implicit assumption throughout these articles is that the use of ADs by patients is not only ethically acceptable but is, indeed, a good thing. Previous literature gives ample warrant for this assumption. Those of us who have quibbled with ADs in References 1. Reilly BM, Magnussen CR, Ross J, Ash J, Papa L, Wagner M. Can we talk? inpatient discussions about advance directives in a community hospital . Arch Intern Med. 1994;154:2299-2308.Crossref 2. Morrison RS, Morrison EW, Glickman DF. Physician reluctance to discuss advance directives: an empiric investigation of potential barriers . Arch Intern Med. 1994;154:2311-2318.Crossref 3. Markson LJ, Fanale J, Steel K, Kern D, Annas G. Implementing advance directives in the primary care setting . Arch Intern Med. 1994;154:2321-2327.Crossref 4. Loewy EH. Advance directives and surrogate laws: ethical instruments or moral cop-out? Arch Intern Med. 1992;152:1973-1976.Crossref 5. Drane JF. The many faces of competency . Hastings Cent Rep. 1985;15:17-21.Crossref 6. Schade SG, Muslin H. Do not resuscitate decisions: discussions with patients . J Med Ethics. 1989;15:186-190.Crossref 7. Involving patients in do-not-resuscitate decisions: an old issue raising its ugly head . J Med Ethics. 1991;17:156-160.Crossref 8. Gordon DR. Culture, cancer and communication in Italy . Anthropol Med. 1991; 7:137-156. 9. Dalla-Vorgia P, Katsouyanni K, Garanis TN, Touloumi G, Drogari P, Koutselinis A. Attitudes of a Mediterranean population to the truth-telling issue . J Med Ethics. 1992;18:67-74.Crossref 10. Danis M, Garrett J, Harris R, Patrick D. Stability of choices about life-sustaining treatments . Ann Intern Med. 1994;120:567-573.Crossref 11. Campbell ML, Carlson RW. Terminal weaning from mechanical ventilation: ethical and practical considerations for management . J Crit Care . 1992;1:52-56. 12. Lee D, Swinburne AJ, Fedullo AJ, Wahl GW. Withdrawing care: experience in medical intensive care unit . JAMA . 1994;271:1358-1361.Crossref 13. Schneiderman LJ, Kronick R, Kaplan RM, Anderson JP, Langer RD. Effects of offering advance directives on medical treatment and costs . Ann Intern Med. 1992;117:599-606.Crossref 14. Teno J, Lynn J, Phillips R, et al. Do advance directives save resources? Clin Res. 1993;41:551A. Abstract. 15. Loewy EH. Futility and the goals of medicine: concepts in need of social definition . Eur Phil Med Health Care . 1993;1:15-29. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Talking, Advance Directives, and Medical Practice

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420200011001
Publisher site
See Article on Publisher Site

Abstract

Abstract THREE ARTICLES in the current issue of the Archives analyze the willingness of physicians to talk to their patients about end-of-life concerns. One of these articles1 also studies the patient's desire for such a conversation. Not surprisingly, many physicians continue to be unwilling to talk to their patients about such matters despite the fact that most patients (as well as the physicians themselves when they see themselves as patients) would want to participate in such discussions.1-3 In the study by Markson et al,3 an educational intervention of both didactic material and practical experience is employed to facilitate the use of advance directives (ADs) by physicians. An implicit assumption throughout these articles is that the use of ADs by patients is not only ethically acceptable but is, indeed, a good thing. Previous literature gives ample warrant for this assumption. Those of us who have quibbled with ADs in References 1. Reilly BM, Magnussen CR, Ross J, Ash J, Papa L, Wagner M. Can we talk? inpatient discussions about advance directives in a community hospital . Arch Intern Med. 1994;154:2299-2308.Crossref 2. Morrison RS, Morrison EW, Glickman DF. Physician reluctance to discuss advance directives: an empiric investigation of potential barriers . Arch Intern Med. 1994;154:2311-2318.Crossref 3. Markson LJ, Fanale J, Steel K, Kern D, Annas G. Implementing advance directives in the primary care setting . Arch Intern Med. 1994;154:2321-2327.Crossref 4. Loewy EH. Advance directives and surrogate laws: ethical instruments or moral cop-out? Arch Intern Med. 1992;152:1973-1976.Crossref 5. Drane JF. The many faces of competency . Hastings Cent Rep. 1985;15:17-21.Crossref 6. Schade SG, Muslin H. Do not resuscitate decisions: discussions with patients . J Med Ethics. 1989;15:186-190.Crossref 7. Involving patients in do-not-resuscitate decisions: an old issue raising its ugly head . J Med Ethics. 1991;17:156-160.Crossref 8. Gordon DR. Culture, cancer and communication in Italy . Anthropol Med. 1991; 7:137-156. 9. Dalla-Vorgia P, Katsouyanni K, Garanis TN, Touloumi G, Drogari P, Koutselinis A. Attitudes of a Mediterranean population to the truth-telling issue . J Med Ethics. 1992;18:67-74.Crossref 10. Danis M, Garrett J, Harris R, Patrick D. Stability of choices about life-sustaining treatments . Ann Intern Med. 1994;120:567-573.Crossref 11. Campbell ML, Carlson RW. Terminal weaning from mechanical ventilation: ethical and practical considerations for management . J Crit Care . 1992;1:52-56. 12. Lee D, Swinburne AJ, Fedullo AJ, Wahl GW. Withdrawing care: experience in medical intensive care unit . JAMA . 1994;271:1358-1361.Crossref 13. Schneiderman LJ, Kronick R, Kaplan RM, Anderson JP, Langer RD. Effects of offering advance directives on medical treatment and costs . Ann Intern Med. 1992;117:599-606.Crossref 14. Teno J, Lynn J, Phillips R, et al. Do advance directives save resources? Clin Res. 1993;41:551A. Abstract. 15. Loewy EH. Futility and the goals of medicine: concepts in need of social definition . Eur Phil Med Health Care . 1993;1:15-29.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 24, 1994

References