Thread: Advance Directives 'not honored here'

Have any coordinators seen the email going around that indicates that one of Jehovah's Witnesses 'read the fine print' on an admissions form at a hospital when preparing for surgery and it stated something to the effect of "Advance Directives are not honored in this facility" and that treatment would be provided based on the physician's opinion of what was best for the patient.? I was shown this email by someone and would be interested to know what facility would include something like this that sounds as though it was written specifically for our patient population. Any idea if this is valid?

I don't think it is legal to "not honor" Advance Directives. These are legal documents that are recognized, to my knowledge, by state law in nearly every state in this country. I don't have the specific citations, but I believe that up to the United States Supreme Court, a patient's right to direct his/her own health care, including refusal of any and all treatment up to and including heroic or "life saving" measures, has been upheld repeatedly by courts. This "fine print", if it exists, would probably not be upheld as a valid giving of contractual permission in any court, especially if it only appears as "fine print". Any contract lawyers out there who might have the legal take on this? I am a former paralegal, but don't profess to have specific expertise in health care matters from this particular standpoint. I believe it would be considered a valid legal basis for a proceeding in assault and/or battery if a medical provider violated a person's wishes with regard to how his/her body is to be treated (or not).

That e-mail has been making the circuit for at least a month now, and I've probably received it at my home address 3 different times from people who know I manage a Blood Conservation Program. All's I can say is there was not enough specifics in the e-mail to make me think it is credible. Regarding hospital's and DPA's or Advance Directives, we would be violating patient rights if we disregard these documents. The 1991 Patient Self-Determination Act requires that patients are informed about their right to participate in health care decisions, including their right to have an advance directive. So it is unlikely that any accredited facility would risk their license by violating patient rights and sneaking something into the fineprint of a consent form.

I have received the email in question from various ones around the country. The following is the direct portion of the email that has caused some concern:

Now check this. Before a particular procedure I was given 3 pages to read with all kinds of stuff in small type: what problems had I ever had in the past; operations; meds I take, etc., the usual stuff. At the end I had to sign the papers. I assume that 99% of us trust our doctors and we sign, never expecting to run into a paragraph like this (word for word):
"I understand that advance directives are NOT honored at [this medical Center] and in the event of a life-threatening situation, emergency medical procedures will be instituted in every instance and patients will be transferred to a higher level of care where the decision to continue or to terminate emergency measures can be made..."

Comments - This is not an epidemic. Hospitals are required to accept advance medical directives, even making forms available for ones who might need them. I'm not sure from the content provided that this was a hospital at all. It may have been an out-patient surgery center (a number of which are associated with hospitals). If a patient in these facilities take a turn for the worse, the patient will be subsequently transferred to a hospital (this may be the higher level of care indicated in the email in question).

I wonder why the facility was not named? That would have been the best way to provide an alert for anyone who might consider going to that facility, instead of giving the impression that this wording is or may become universal.

One more thought - All language on consent forms should be checked thoroughly prior to signing, even at facilities that offer bloodless medicine and surgery.

I have received the same e mail, also a freind has told me that her family practice had a similar sign. I will have to check it out

Thank you very much tbam69a, I think reading it with the thought in mind that it is perhaps in an outpatient center or doctor's office, this makes more sense. They would start CPR and transfer to a higher level facility. It certainly would have been more helpful if the institution or type of institution had been included. It seems to be very alarming, especially to those outside the field. A lay person reads that and instantly is on the defensive. Up to now when asked about it I've just said, as you all did, that it's ALWAYS the smart consumer that reads everything before signing...and that in this world there's always fine print. It's our job to be aware and prepared. Thank you for the great input!

I have also received this email. Just to reiterate what was previusly said, to honor an advance directive is up to each individual state. to paraphrase the Risk Management Handbook for Health Care Organizations: "State laws differ as to the form of execution of such advance directives... Each physician should consult applicable state law concerning the matter."
There are various state and federal definitions of compentence and various statutory definitions of what is meant by "life support", that is, whether hydration and nutrition are included or excluded.
I have seen many patient's sign a "Permission to treat" and not read the fine print. The fine print may state that the physician can give among other things a blood transfusion if necessary. Make sure that you read the whole document before signing. It is perfectly OK to draw a line for what you do not agree, and initial it.

My dad had cataract removal. The facility had the same info. He questioned why. They said it is because if someone "falls out" they will send them to the ER and not honor wishes such as "DNR". Then the ER would have to honor the advance directive

What most DPA's actually say is " I do not want my life to be prolonged if , to a reasonable degree of medical certainty, my situation is hopeless"
Can a Dr's office or for that matter an ambulance crew make that decision? Not really. A DNR is reserved mostly for people in hospice or people with end stage chronic conditions.
That may be what those signs may be referring to. As far as a blood tranfusion most clinics and ambulances do not carry blood. So optimally the hospital will honor your DPA when you get there.

Anything you have to sign is a contract. If you find such a statement on a form, you simply mark it out and put your initials next to it. The hospital attendant then has the right to reject the form or the doctor to refuse to give you treatment. It becomes their choice. If they ignore your adjustments to the form, it is considered quiet consent.