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Advance directives are available for individual states online, http://www.caringinfo.org/PlanningAhead.htm, and an attorney isn't needed, a popular misconception, Silveira said.
"We don't expect perfection out of these documents," she said. "They're there to make a difficult situation maybe a little bit less so."
The study's results, while "tantalizing", haven't convinced Dr. Muriel Gillick of Harvard Medical School that living wills are all that useful. Ideally, older patients, along with their proxy, should discuss their medical condition, goals and treatment options with a physician -- instead of just signing a form, she said.
In an editorial in the journal, Gillick said the findings nevertheless "demonstrate that talking about the goals of medical care has become acceptable to a large majority of Americans who need it most."
An alternative, she said, is a program with a more detailed form that includes doctor's orders for specific care -- called "physician orders for life-sustaining treatment." The program has been adopted in a few states.
One community that has embraced advanced directives is La Crosse, Wis. A citywide program grew out of the counseling experience of Bernard "Bud" Hammes at Gundersen Lutheran hospital. Hammes said he saw how distressing it was for three families who had to decide whether to continue dialysis for patients who had suffered serious strokes.
He asked them what their relative would want. "In all three cases, the family said: 'We have no idea. We never talked about it,'" he recalled.
A program called Respecting Choices is now used by the city's hospitals, nursing homes and other health-care providers. Today, most patients -- 85 percent -- have a care plan when they die, he said.
On the Net:
New England Journal: http://www.nejm.org/
State advance directives:
Physician's orders: http://www.ohsu.edu/polst/
Respecting Choices: http://respectingchoices.org/
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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