Most physicians do not want intense care near the end of life

Only one-third of Americans have an advance directive

Nearly 90% of physicians say they would give a do-not-resuscitate order if they were terminally ill, according to a new study from the Stanford University School of Medicine.

The ABCDEs of advance care planning

For the study, which was published in PLOS One, researchers surveyed nearly 1,100 physicians in 2013 as the physicians were finishing their residency training in various fields.

"We see too much in our practice and training when high-intensity treatments actually hurt patients," says lead author Vyjeyanthi Periyakoil, adding, "We know when terminally ill, treatments only help prolong the dying process, and there is no return on your investment."

Despite the general consensus among physicians, they often must provide patients with intense, end-of-life care that they would not chose from themselves.

How London hospitals are transforming end-of-life care

"A big disparity exists between what Americans say they want at the end of life and the care they actually receive," the researchers wrote, adding, "More than 80% of patients say that they wish to avoid hospitalizations and high intensity care at the end-of-life, but their wishes are often overridden."

Advance directives help physicians make decisions based on patients' wishes, but only about one-third of U.S. adults have one, according to data from the Pew Research Center

Why one hospital CEO is wary of advance directives

"I think as health care becomes more a part of American life, the issue of advance directives will be less amenable to controversy," says Rep. Sandy Levin (D-Michigan), who authored the Patient Self-Determination Act.

In 2008, Levin proposed legislation that would require physicians to have a discussion about advance directives when treating a Medicare beneficiary for the first time. During revisions of the Affordable Care Act, the initiative was dropped after critics complained that the practice would establish "death panels," according to Reuters' Randi Belisomo (Belisomo, Reuters, 5/28; Preidt, HealthDay, 5/28).

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