Advance Directives

In 1976, Texas became the second state to pass a law regulating medical treatment decisions near the end of life. In 1997, physicians, providers, and others (including the Texas and U.S. Right to Life Committees) came together to improve that law. The Texas Legislature unanimously adopted the Texas Advance Directives Act (TADA), Gov. George W. Bush signed it, and it has been well received by physicians, providers, and patients.

TADA has had remarkable success in achieving its three major goals:

  • Improving communication and patient choice at the end of life,
  • Decreasing suffering near the end of life, and
  • Providing medically appropriate and compassionate treatment at the end of life without fear of legal intrusion by outside parties.

TADA provides for three types of advance directives (the directive to physicians or living will, the medical power of attorney, and the out-of-hospital do-not-resuscitate (DNR) order). TADA updated the legal definitions of terminal and irreversible illness, making them more compatible with advances in medical practice. TADA also created a process to guide resolution of both right-to-die and medical futility disputes.

Research proves the presence of an advance directive such as a living will is associated with decreased family stress and increased patient comfort. In the absence of advance directives, however, families find making treatment decisions near the end of life for terminally ill loved ones extremely stressful, and the family is more likely to insist upon ineffective and expensive treatments that increase patient suffering.

Medicine's 2011 Agenda

  • Pass legislation that promotes advance care planning and the completion of advance directives.
  • Financially support pilot programs in urban and rural counties to implement systematic advance care planning in a variety of chronic care sites.
  • Create a single page physician order sheet that ensures a patient's wishes will actually follow the patient.

Medicine's Message

  • TADA was a good law when passed; it remains a good law today. One of its most important goals is to relieve suffering at the end of life. Suffering is not inevitable. We can see it coming, plan to deal with it appropriately, and follow those plans.
  • Although advance directives have proven benefits for patients and families, few patients have them.
  • Advance care planning includes an ongoing dialogue among patient, family, and physician, and must begin when the patient is not under the stress of a health crisis.

 


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