Avoiding Misunderstandings With Advanced Medical Directives

end of life care, elderly patient and nurse
By: Donna Nicholson, MBA, BSN, RN, CPCO
2 Minute Read

Family members’ confusion regarding end-of-life care options and advance directives often lead to allegations of medical negligence. Thorough education and guidance when discussing potential options with patients and family members is paramount to avoid shock and confusion, particularly in the face of unforeseen circumstances, and to mitigate malpractice claims.

A Common Case

An 83-year old female was admitted to the hospital for a routine angiogram. The physician had no reason to anticipate complications, but the patient’s age and history of heart disease made her vulnerable to potential adverse consequences. Unfortunately, following the procedure, the family was shocked to learn that an unforeseen complication took the life of their loved one, as a previously signed Do Not Resuscitate (DNR) order prevented staff from taking additional measures to save the patient’s life.

Though they were aware of the DNR, family members could not understand why the physician would allow their loved one to die of unnatural causes resulting from what should have been a routine procedure. This is not what they believed they signed up for, and they sought retribution against the physician.

3 Keys to Clarity

Discussing end-of-life care options is one of the most emotional conversations that a patient can have with their doctor. There is very little that a physician can do to ease the pain and fear associated with these decisions, but it’s their obligation to arm patients and their families with as much knowledge and information as possible to ensure they are making an informed choice.

1. Talk Through Options

Patients have a wide range of options available to them when deciding how they would like to handle end-of-life care decisions. Some options include DNR orders, Physician/Medical Orders for Life-Sustaining Treatment (POLST or MOLST), and specific medical intervention advance directives. Physicians should outline the various options and explain the differences to patients and their families, so they can choose the option that best meets their individual needs.

2. Help Families Understand Implications

Once a patient and their family choose an option for end-of-life care directives, it’s important that the physician clearly communicates the entire scope of this decision, providing examples of potential situations. This will help ensure that they are prepared when and if the time comes for this order to be enacted.

3. Encourage Families to Speak Up

Physicians should teach patients and their families how to advocate for themselves or their loved one when necessary. Care moves quickly in emergency situations, and it’s important that patients know how to speak up about any advanced directives as quickly and clearly as possible to avoid an unwanted outcome.

Exceptions to the Rule

Some practices and hospitals implement ethical guidelines surrounding end-of-life care directives, providing physicians with the option to bypass certain orders under unusual circumstances. It’s important that doctors know and understand these exceptions to proactively prepare for the unexpected.

When armed with the necessary information, physicians can act quickly and with confidence to provide the best care possible within limits of patient wishes and avoid potential liability.

For further guidance on this issue, Curi members are encouraged to reach out to our Risk Management Departments at 800.662.7917.

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Donna Nicholson, MBA, BSN, RN, CPCO
Donna Nicholson is Curi Advisory's Managing Director of Risk Solutions based in Raleigh, NC.

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