It's precisely because of cases like Bellmore's that states have begun making medical directive laws more patient-friendly, says Charles Sabatino, an attorney with the American Bar Association's Commission on Legal Problems of the Elderly. While all 50 states and the District of Columbia recognize advance directives, Sabatino cautions people to fill out such forms according to each state's laws because requirements may be different. Some states, for example, require witnesses and/or notarization.
Making Medical Directives Stick
Typically, the two biggest barriers to meeting a dying patients' wishes met are lack of communication with family and doctors — and the reluctance by many physicians to allow a dying patient to go without a medical fight.
"One of the biggest reasons advance care planning fails is that physicians and patients haven't discussed it," says Damon Marquis, author of Advance Care Planning: A Practical Guide for Physicians. "So many people think advance care planning is a piece of paper and an one-shot deal. But it's not."
Make your wishes known to your family and doctors when you are well enough to communicate, advises Coombs Lee. "Completing the form should be a family affair and should not be done in isolation," she stresses.
"The goal of an advance directive is not only to encourage health care providers to carry out our own wishes if we become incapable of saying so, but also to lighten the burden of decision-making on family and loved ones to whom this duty will fall," Coombs Lee says.
A well written medical directive is likely "to change the tone of the conversation" for the better between families and doctors who are trained to give more — not less — treatment, Coombs Lee adds. Although the American Medical Association is raising awareness among physicians about end-of-life care, Coombs Lee says physicians' attitudes are evolving "slowly."
You want to also be sure a directive is in your medical file, otherwise, as Bellmore's case illustrates, doctors may not honor the patient's wishes. This is especially important given that "most times that directive doesn't end up in the medical chart," says Sabatino. "Most commonly, the documents are never seen or read."
Finally, choose a physician based on his/her willingness to talk about and respect a patient's views on end-of-life care. "It's never too early to talk about this issue with one's physician," says Coombs Lee.