Limitations of listing specific medical interventions in advance directives

Article Abstract:

In a recent US Supreme Court decision, the ruling of the Missouri Supreme Court was upheld, insisting upon the maintenance of life-sustaining treatment for a patient unless clear and convincing evidence were available that the patient did not wish such treatment. The decision resulted from the case of Nancy Cruzan, who was in a persistent vegetative state after an automobile accident. Although friends and relatives testified that she would have wanted mechanical support shut off, this was not regarded as convincing by the state. This case, and similar cases, has prompted consideration by many of living wills, in which a person records his wishes before an event occurs that might rob the person of their ability to decide for themselves. The Medical Directive is a questionnaire that has been widely distributed in the popular press including The New York Times and the Harvard Medical School Health Letter. The questionnaire permits a person to check off various sorts of treatments which may or may not be desired if the patient becomes incapacitated and unable to rationally decide on treatment. Such efforts are laudable, and further efforts should be made to encourage the implementation of living wills of this sort. However, directives that address specific medical treatments may not be appropriate and may ultimately work in direct opposition to the desires of the patient. For example, a person might indicate whether or not he would want antibiotic treatment if severely demented. However, there would be a large difference between the use of antibiotics to treat a case of pneumonia that would be rapidly fatal and the use of antibiotics to treat a case of pneumonia that would not be fatal but would cause significant suffering. In the former case, the patient would suffer minimally if the antibiotics were withheld; in the latter case suffering may be extreme. It should be evident that the value system of the patient is what is important and what should be recorded. Acceptance or refusal of any particular medical treatment is invariably based on the values of the patient and not on any intrinsic property of the treatment. Ironically, the precise specification of treatments as in The Medical Directive may ultimately be used by authorities to circumvent the actual desires that led the patient to fill out the Directive to begin with. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Patients, Living wills, editorial

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Mercury exposure among residents of a building formerly used for industrial purposes - New Jersey, 1995

Article Abstract:

The New Jersey Department of Health in Dec 1995 condemned a five-story residential building and urged all occupants to move after pools of mercury were discovered in the subflooring of the fifth floor and mercury vapor was detected in many of the units. The building had formerly been used to manufacture mercury vapor lamps. Mercury vapor was found in units on all five floors and ranged from approximately 10 to 100 times higher than allowed by law. Over two-thirds of the residents tested had mercury in their urine.

Environmental aspects, Mercury, Mercury (Metal), Condominiums

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Advance Directives for Nursing Home Residents: Achieving Compassionate, Competent, Cost-effective Care

Article Abstract:

Advance directives can be used to provide compassionate but necessary care to terminally ill patients. Advance directives are documents that patients draw up to indicate which treatments they do not want to have in the event they become incompetent to decide in the future. One study found that a program to support the use of advance directives led to lower hospitalization rates and reduced use of healthcare resources. However, it is not clear if the patients in the study received adequate palliative care.

Editorial, Analysis, Evaluation, Advance directives (Medicine), Medical care decision-making authority (Law), Medical care decision making authority (Law)

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