"These documents have good intended purposes [but] there can be bad unintended consequences from them," he says. "In medicine, a large percentage of practicing physicians look at a document like that and define it as a DNR order."
These orders are routinely misunderstood in medicine, he says, and his research backs up that assertion. To patients, an advance directive might contain assumptions about comfort and end-of-life care (as it did with me).
Documents Lack Federal Standardization
But if you present critically ill somewhere and you can't speak for yourself, the presumed assumption, given the presence of an advance directive, may mean that clinicians will withdraw treatment from you—even if you have a treatable condition. It all depends on the person interpreting the document, says Mirarchi.
"I'm in the minority on this," he concedes, "but from my experience in clinical practice and studying it, there is a nationwide patient safety concern with the documents. They lack federal standardization."
A lot of positive change could come if physicians and nurses knew that when presented with such a document, a pause is in order. Mirarchi, with legal help, developed a checklist poster that he says at least helps clinicians make better decisions based on what's in the document, as well as some advice on interpretation.