"I see people all the time who can't speak for themselves that have very treatable conditions and potential[ly] functional outcomes," he says. "To not treat them would be a medical error."
As for himself, Mirarchi has not and has no plans to complete a living will or advance directive. He does however, have a named surrogate, who is his wife.
"I met with my attorney and as part of my estate planning, he had my living will created. When he presented it to me he kind of laughed and said, 'I'm not sure you're going to sign it,'" says Mirarchi. "He was right. I didn't. Until more safeguards are in the process, I wouldn't complete one."
An Advocate for Safeguards
That doesn't mean he thinks advance directives or living wills are necessarily bad ideas, or that they don't have huge potential to save on expensive, end-of-life care for patients who have no reasonable hope of recovery. And he knows that such documents can't be made perfect. But given his experience and research, he believes there are too many potential drawbacks for him personally.
"Every form is going to have a problem and I don't care anymore what people tell me about new processes," he says. "Every one of these forms has someone interpreting it. Their understanding will carry forward and impact care and treatment."