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Study: Living Wills Often Prove Useful
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Study: Living Wills Often Prove Useful

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Study: Living Wills Often Prove Useful

Study: Living Wills Often Prove Useful
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A new medical study looks at a hot issue from the recent debate about the nation's health care system: planning medical care for our final days. The study found that a lot more people have outlined their wishes in advance than previously thought, and that those directives very often prove useful.

MICHELE NORRIS, host:

You're listening to ALL THINGS CONSIDERED from NPR News.

A new study tackles one of the hottest issues of the recent health care debate: planning end of life medical care. It found that a lot more people are outlining their wishes in advance than previously thought.

And, as NPR's Joanne Silberner reports, most get exactly what they ask for.

JOANNE SILBERNER: The discussion caught fire last July when some conservative Republicans pounced on a provision in the House of Representatives' health overhaul plan. The provision would have allowed Medicare to pay for office visits where patients just talked to their doctors about what kind of care they'd want if someday they couldn't express themselves.

The proposal did not go over well with conservative commentator Betsy McCaughey. She complained on former Senator Fred Thompson's radio show that the result would be having to tell old people...

Ms. BETSY MCCAUGHEY: How to end their life sooner, how to decline nutrition, how to decline being hydrated, how to go into hospice care.

SILBERNER: Democrats argued that the government would only encourage people to discuss their wishes. At the time of the debate, Maria Silveira was already in the midst of trying to figure out just what role advanced planning plays in the practice of medicine. Silveira, a doctor with the Department of Veterans Affairs and the University of Michigan, along with some other folks, analyze the records of about 3,800 people who recently died.

First, they looked at how often critical decisions were made when people were critically ill, decisions like whether a doctor should perform surgery. They tallied the number of people who were too sick to say yes or no on their own.

Dr. MARIA SILVEIRA (Department of Veterans Affairs, University of Michigan): Almost 30 percent of the elderly in the study overall needs someone to make a complex medical decision on their behalf before they die.

SILBERNER: Now, most people had either a written statement about what they wanted or they'd assign a person to decide for them. The numbers were high because of a law passed in 1990 that requires that hospitals inform adult patients about their options.

Silveira's next question was: Were people's wishes followed? Ninety-seven percent of the people who put down a preference for enough care to just keep them comfortable got it. Eighty-three percent who wanted limited care got what they wanted. Very few people who requested all care possible, just half of them got it, she says.

Dr. SILVEIRA: The disparity with all care possible, I think, can be explained by the fact that all care possible isn't always an option.

SILBERNER: For example, CPR won't save someone with multiple organ failure. And in many of the all care cases, family members called doctors off. The New England Journal of Medicine has just published Silveira's study. The information about how often someone other than the patient must make an end-of-life decision is useful, says geriatrician Muriel Gillick of Harvard Medical School. But she's not so sure about the value of filling out a form.

Dr. MURIEL GILLICK (Harvard Medical School): The kinds of legalistic advanced directives that people typically sign are rarely genuinely applicable in the many different situations that people find themselves in.

SILBERNER: She says better is a conversation with trusted doctors, the sort of thing the House bill would have encouraged but the provision was pulled when the debate got hot.

Study author Silveira remembers an elderly woman she treated. The woman's eight children argued for months about what to do while their mother laid dying in the intensive care unit.

Dr. SILVEIRA: Short of a miracle, nothing would have made this situation easy, you know, for the family. But had these documents been there, it would've been a little bit less difficult.

SILBERNER: Any indication of what the woman wanted would've been a help, she says.

Joanne Silberner, NPR News.

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