Physician: 'I Almost Killed a Patient' Because of an Advance Directive

Philip Betbeze, for HealthLeaders Media , May 2, 2014

All of that said, and given his hesitancy to do a living will or advance directive of his own, Mirarchi still wants to be able to advocate for their proliferation.

"But first I need to advocate for safeguards," he says. "They do have a lot of benefits, and I'm not discouraging anyone from doing one, because there's no question they do save money and resources. Those patients who are not gaining any benefit from treatment are very expensive. But first I need to advocate for safeguards."

So what am I and others like me to do? We want to do the right thing, we want not to be a burden to our families or the healthcare system, but we also don't want to die from a treatable condition because our advance directive has been misinterpreted.

Although my form is one that I downloaded, and Mirarchi correctly asked if I had any assistance of guidance filling it out (I hadn't), I still feel it outlines my wishes appropriately. I've made clear to my wife that if there's any chance of recovery, I want her to authorize treatment.

I trust her.

I could go home and tear up my advance directive, but at some level, I have to hope that's enough.

Philip Betbeze is senior leadership editor with HealthLeaders Media.
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10 comments on "Physician: 'I Almost Killed a Patient' Because of an Advance Directive"

mike (5/19/2014 at 1:53 PM)
I think the advanced directive is a great idea but the forms need to be concise and the pateints should be registered in a place where any MD or RN can look up the entire nature of the "directive". If I have an AD will I carry it if I am traveling? Probably not, but if I have terminal cancer and I suddenly embolize do I want them to intubate me and put me on life support while they attempt to tPA the clot? As a clinician in cardiovascular surgery I saw many that were armed with an AD but the kids wanted the MD to do "anything possible" a real violation of the directive. If health care workers could have access to a national DB this may not happen as often as it does.

Mary Hannon RN (5/6/2014 at 9:37 PM)
I think everyone should have Advanced Directives, as well if they have an irreversible condition a DNR in place. That being said, I have always believed and said just because a patient is a DNR does not mean they are a do not treat. If a patient has Advanced Directives I place, one would hope they have spoken to the designated health care proxy named. While that certainly in reality is not always the case, means we need too scrutinize their wishes more carefully and pose the appropriate questions to that Health Care Proxy. Especially if this time it happens to be a reversible condition. In terms of a DNR status, as I said it does not mean don not treat. So, we also need to understand that simply says, no CPR. It does not say no treatment.

Robert Bramel (5/6/2014 at 2:58 PM)
As an elderly non-medical individual I am quite amazed at the apparent confusion by many in the medical community about the intent of advanced directives. The concept seems clear enough; maintenance of life is not enough, there must be some reasonable chance for reasonable quality of life at the end of treatment. It is not enough to extend the life of someone who will never leave a bed again or communicate again. Of course there will be difficulties with "reasonable chance" (e.g., 50/50, 1 in ten) and "reasonable quality of life" (e.g., mental function, physical abilities), but those are the real issues that need to be addressed. ER doctors ought to have clear guidelines that inform automatic responses without need for reading and interpreting AD legalese. Rather than complain about advanced directives, the community needs to spend more time coming to grips with these issues. Too many medical doctors I've talked to seem to believe that "do no harm" means attempting to keep vital organs functioning at all costs without regard to whether there is going to be anything meaningful left in the patient. Leaving a patient in a nonfunctioning vegetative state is enormously "harmful". Virtually everyone I've ever talked to about end of life issues, and I've talked to many, agree that no one who thinks about it wants to be kept alive connected to tubes, incommunicado, with no chance of a real life ever again. Why this seems hard for so many medical professionals remains puzzling.




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