Physicians' attitudes on advance directives

Article Abstract:

Advance directives, such as living wills and durable powers of attorney, are important documents used in making medical decisions for incompetent patients. They enable a competent person to make certain decisions regarding future medical treatment. In living wills people formally states their wishes for their health care; this document is used if the person is too ill to express these wishes. A durable power of attorney allows patients to appoint a person who will make decisions for them if they are unable to do so themselves. Much of the previously published material regarding advance directives has focused on theoretical issues. This study sought to gather evidence from practicing physicians regarding their opinions about advance directives. Questionnaires were sent to 1,293 physicians in general practice, family practice and internal medicine. Data were obtained from the 790 physicians who responded (65.2 percent). Almost 80 percent of the respondents had positive attitudes toward the use of advance directives; 19.3 percent had neutral views or no opinion; 1.5 percent expressed a negative attitude. More than half of the responding physicians (55.9 percent) had actual experience with advance directives, and 83.5 percent of these physicians felt that this had caused them to develop a more positive attitude concerning the use of advance directives. Physicians' positive attitudes were strongly associated with frequent use of advanced directives in critical situations. The results of this study support many of the benefits previously associated with the use of advance directives, such as improving communication and trust between doctor and patient, allowing the physician to make treatment decisions more confidently and with less stress, and permitting patients to retain control of their medical care.

Analysis, Physician and patient, Physician-patient relations, Confidential communications, Physician-patient privilege, Life and death, Power over, Power over life and death

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Hospital policy on advance directives; do institutions ask patients about living wills?

Article Abstract:

Living wills and durable powers of attorney, known as advance directives, are important legal tools for making medical decisions for incompetent patients. In living wills people formally state their wishes regarding their future health care; this document is used if the patient is too ill to express these wishes. A durable power of attorney allows patients to appoint a person who will make medical decisions for them if they are not capable of doing so. Many states have some form of advanced directive or 'natural death' legislation. The authors wished to discover if hospitals have policies regarding these advance directives. In a random sample 219 hospital administrators completed a questionnaire. About two-thirds of the responding hospitals have a formal policy regarding advance directives. The authors note a potential bias in their study because larger hospitals were overly represented; large hospitals may be more likely to have such formal policies than small hospitals. The hospital ethics committee, if there was one, had reviewed advance directive policies in only 43 percent of the hospitals responding. Most of the hospitals required that patients notify them if an advance directive existed, but only four percent of the hospitals actually asked the patients if they had one. The authors suggest that hospitals adopt formal policies to ask all adult patients, at the time of their admission, whether they have prepared an advanced directive or similar document.

Hospitalization, Hospital care

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Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings

Article Abstract:

Selective HIV testing in acute-care hospitals could identify up to 68% of HIV-positive individuals who are treated for reasons besides HIV infection or AIDS. Early detection and treatment of HIV infection may curb the spread of HIV and delay or prevent the onset of opportunistic infections and AIDS. Recent studies found that up to 9% of people treated in emergency rooms and admitted to acute-care hospitals are HIV positive and that about 65% are not aware of their infection prior to treatment. The CDC recommends that hospitals have clinicians routinely ask patients about risks for infection with HIV. Hospitals with an HIV seroprevalence rate of 1% or more should regularly offer testing and counseling to patients aged 15 to 54, and all hospitals should develop a policy for HIV testing and counseling. Test results should be confidential, and testing and counseling should not be conducted in emergency situations.

Management, HIV testing, HIV tests

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