That Living Will You Signed? At the ER, It Could Be Open to Interpretation

Jul 13, 2018 / Amanda Chase, Horsesmouth Assistant Editor

One of the most important documents a retiree can have is a health care directive. But what does that mean, exactly? Is it a living will? A Do Not Resuscitate order? Is there a difference? There are actually many types of end-of-life documents, and sometimes not even medical professionals know the difference. One expert says that misunderstandings involving documents meant to guide end-of-life decision-making are “surprisingly common.”

But health systems don’t systematically track mix-ups of this kind, and they receive little attention amid the push to encourage older adults to document their end-of-life preferences. A new report out of Pennsylvania, which has the nation’s most robust system for monitoring patient safety events, treats mix-ups involving end-of-life documents as medical errors—a novel approach. It found that in 2016, Pennsylvania health care facilities reported nearly 100 events relating to patients’ “code status”—their wish to be resuscitated or not, should their hearts stop beating and they stop breathing. In 29 cases, patients were resuscitated against their wishes. In two cases, patients weren’t resuscitated despite making it clear they wanted this to happen. The rest of the cases were “near misses”—problems caught before they had a chance to cause permanent harm.

The problem, one expert explained, is that doctors and nurses receive little, if any, training in understanding and interpreting living wills, DNR orders and Physician Orders for Life-Sustaining Treatment (POLST) forms, either on the job or in medical or nursing school. Communication breakdowns and a pressure-cooker environment in emergency departments, where life-or-death decisions often have to be made within minutes, also contribute to misunderstandings, other experts said.

For the full article, including further research and basics about end-of-life documents, visit Kaiser Health News.


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