Guest guest Posted July 24, 2004 Report Share Posted July 24, 2004 The two most lied about professions for emergency patients. ED Clerk: " What is your occupation? " Chiropractor: " Health care, sort of. " Lawyer: " Landscaping " Re: DNR Again Most doctors will treat the lawyers who get them out of their speeding tickets, handle their divorces and try to save their fortunes for them when their wife comes home early on Wednesday afternoon and catches them in bed with Nurse Barbie, and who set up their corporations for them and show them how to hide their assets in Grand Cayman. GG In a message dated 7/24/2004 1:29:07 PM Central Daylight Time, lnmolino@... writes: In a message dated 7/24/2004 8:48:30 AM Central Daylight Time, donnie7435@... writes: Now a days you aren't treating the patient, you are treating the lawyers.... God I hope not! Besides some in the AMA say that DR's should not treat lawyers anyway right? Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI LNMolino@... (Home Office) " A Texan with a Jersey Attitude " The comments contained in this E-mail are the opinions of the author and the author alone. I in no way ever intend to speak for any person or organization that I am in any way whatsoever involved or associated with unless I specifically state that I am doing so. Further this E-mail is intended only for its stated recipient and may contain private and or confidential materials retransmission is strictly prohibited unless placed in the public domain by the original author. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2004 Report Share Posted July 24, 2004 The two most lied about professions for emergency patients. ED Clerk: " What is your occupation? " Chiropractor: " Health care, sort of. " Lawyer: " Landscaping " Re: DNR Again Most doctors will treat the lawyers who get them out of their speeding tickets, handle their divorces and try to save their fortunes for them when their wife comes home early on Wednesday afternoon and catches them in bed with Nurse Barbie, and who set up their corporations for them and show them how to hide their assets in Grand Cayman. GG In a message dated 7/24/2004 1:29:07 PM Central Daylight Time, lnmolino@... writes: In a message dated 7/24/2004 8:48:30 AM Central Daylight Time, donnie7435@... writes: Now a days you aren't treating the patient, you are treating the lawyers.... God I hope not! Besides some in the AMA say that DR's should not treat lawyers anyway right? Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI LNMolino@... (Home Office) " A Texan with a Jersey Attitude " The comments contained in this E-mail are the opinions of the author and the author alone. I in no way ever intend to speak for any person or organization that I am in any way whatsoever involved or associated with unless I specifically state that I am doing so. Further this E-mail is intended only for its stated recipient and may contain private and or confidential materials retransmission is strictly prohibited unless placed in the public domain by the original author. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2004 Report Share Posted July 25, 2004 Ralph, If you'll go and read the statute you'll see that this is intertwined with the parts that allow patient surrogates to make DNR decisions for the patient if the patient cannot. That part also empowers those surrogates to revoke. So it's actually in the law. The lawmakers and legal profession are quite reluctant to enact an ironclad provision because of the myriad types of interference and manipulations that can conceivably allow someone with bad or criminal motives to engineer the death of somebody. The problems are compounded when decisions must be made on the spur of the moment. In another post that I made just a few minutes ago I quoted the ACLS Textbook on this subject. GG In a message dated 7/25/2004 7:12:43 PM Central Daylight Time, rbr@... writes: Gene, Thanks for the answer. That’s what I thought, but as I understand the intent when this was discussed in the legislature, it was to be a vehicle for people who did not want to be resuscitated to be able to let us to let them die in peace. Now we have dissected the wording to mean do what the family wants. Doesn’t this defeat the original intent of the law? Ralph , LP wegandy1938@... wrote: Ralph, Great question. I interpret the law to say " yes. " There have been no court decisions on that subject, so any answer that I give is presumptive, but on the theory of always working the code when in doubt, I would say work it to be safe. Now, I'll twist your mind a little bit. Let's say that there are a son and a daughter present who are both adults and one of them wants her worked and the other one does not. What then? GG In a message dated 7/23/2004 8:06:28 AM Central Daylight Time, rbr@... writes: Gene, Does this mean that if granny has a cardiac arrest with a DNR on hand, that her son can revoke it because she is no longer possess " present legal capacity " and is not legally mentally competent? Ralph , LP wegandy1938@... wrote: I'll try to guide y'all through an analysis of this. Scroll down. Gene G. In a message dated 7/22/2004 2:50:31 PM Central Daylight Time, supervisor@... writes: I've sent this out before, but received very little input other than a few opinions. Does anyone have any factual info? If a person signs a DNR while they are competent and able to make reasonable and informed decisions about their healthcare, can a family member or POA revoke or rescind that DNR later in the person's life when they are deemed to be incompetent or unable to decide for themselves? Go to this site and look at the form, and it will explain the procedures clearly. http://www.tdh.state.tx.us/hcqs/ems/dnr.pdf The patient may execute the DNR at a time when he is mentally competent (an incorrect term--the patient must possess " present legal capacity " as well as being legally mentally competent. Loose language has been an ongoing problem with these issues). If the patient is lacks the capacity to execute the DNR, it may be executed by anyone who has the legal right to make such a determination under the law, which is found in the Texas Family Code for Texas patients. If there are no patient surrogates available or they do not want to act, two physicians may execute the document. The DNR may be revoked by ANY of the persons qualified to execute it. Therefore, it a patient has executed a DNR at a time when he had present mental capacity and legal competence, but later becomes incompetent, any of the surrogates may revoke it. This is spelled out in detail on the back of the official DNR form. Best, GG Bullard BS, LP Training Coordinator Lubbock Aid Ambulance Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2004 Report Share Posted July 25, 2004 Ralph, If you'll go and read the statute you'll see that this is intertwined with the parts that allow patient surrogates to make DNR decisions for the patient if the patient cannot. That part also empowers those surrogates to revoke. So it's actually in the law. The lawmakers and legal profession are quite reluctant to enact an ironclad provision because of the myriad types of interference and manipulations that can conceivably allow someone with bad or criminal motives to engineer the death of somebody. The problems are compounded when decisions must be made on the spur of the moment. In another post that I made just a few minutes ago I quoted the ACLS Textbook on this subject. GG In a message dated 7/25/2004 7:12:43 PM Central Daylight Time, rbr@... writes: Gene, Thanks for the answer. That’s what I thought, but as I understand the intent when this was discussed in the legislature, it was to be a vehicle for people who did not want to be resuscitated to be able to let us to let them die in peace. Now we have dissected the wording to mean do what the family wants. Doesn’t this defeat the original intent of the law? Ralph , LP wegandy1938@... wrote: Ralph, Great question. I interpret the law to say " yes. " There have been no court decisions on that subject, so any answer that I give is presumptive, but on the theory of always working the code when in doubt, I would say work it to be safe. Now, I'll twist your mind a little bit. Let's say that there are a son and a daughter present who are both adults and one of them wants her worked and the other one does not. What then? GG In a message dated 7/23/2004 8:06:28 AM Central Daylight Time, rbr@... writes: Gene, Does this mean that if granny has a cardiac arrest with a DNR on hand, that her son can revoke it because she is no longer possess " present legal capacity " and is not legally mentally competent? Ralph , LP wegandy1938@... wrote: I'll try to guide y'all through an analysis of this. Scroll down. Gene G. In a message dated 7/22/2004 2:50:31 PM Central Daylight Time, supervisor@... writes: I've sent this out before, but received very little input other than a few opinions. Does anyone have any factual info? If a person signs a DNR while they are competent and able to make reasonable and informed decisions about their healthcare, can a family member or POA revoke or rescind that DNR later in the person's life when they are deemed to be incompetent or unable to decide for themselves? Go to this site and look at the form, and it will explain the procedures clearly. http://www.tdh.state.tx.us/hcqs/ems/dnr.pdf The patient may execute the DNR at a time when he is mentally competent (an incorrect term--the patient must possess " present legal capacity " as well as being legally mentally competent. Loose language has been an ongoing problem with these issues). If the patient is lacks the capacity to execute the DNR, it may be executed by anyone who has the legal right to make such a determination under the law, which is found in the Texas Family Code for Texas patients. If there are no patient surrogates available or they do not want to act, two physicians may execute the document. The DNR may be revoked by ANY of the persons qualified to execute it. Therefore, it a patient has executed a DNR at a time when he had present mental capacity and legal competence, but later becomes incompetent, any of the surrogates may revoke it. This is spelled out in detail on the back of the official DNR form. Best, GG Bullard BS, LP Training Coordinator Lubbock Aid Ambulance Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2004 Report Share Posted July 25, 2004 Ralph, If you'll go and read the statute you'll see that this is intertwined with the parts that allow patient surrogates to make DNR decisions for the patient if the patient cannot. That part also empowers those surrogates to revoke. So it's actually in the law. The lawmakers and legal profession are quite reluctant to enact an ironclad provision because of the myriad types of interference and manipulations that can conceivably allow someone with bad or criminal motives to engineer the death of somebody. The problems are compounded when decisions must be made on the spur of the moment. In another post that I made just a few minutes ago I quoted the ACLS Textbook on this subject. GG In a message dated 7/25/2004 7:12:43 PM Central Daylight Time, rbr@... writes: Gene, Thanks for the answer. That’s what I thought, but as I understand the intent when this was discussed in the legislature, it was to be a vehicle for people who did not want to be resuscitated to be able to let us to let them die in peace. Now we have dissected the wording to mean do what the family wants. Doesn’t this defeat the original intent of the law? Ralph , LP wegandy1938@... wrote: Ralph, Great question. I interpret the law to say " yes. " There have been no court decisions on that subject, so any answer that I give is presumptive, but on the theory of always working the code when in doubt, I would say work it to be safe. Now, I'll twist your mind a little bit. Let's say that there are a son and a daughter present who are both adults and one of them wants her worked and the other one does not. What then? GG In a message dated 7/23/2004 8:06:28 AM Central Daylight Time, rbr@... writes: Gene, Does this mean that if granny has a cardiac arrest with a DNR on hand, that her son can revoke it because she is no longer possess " present legal capacity " and is not legally mentally competent? Ralph , LP wegandy1938@... wrote: I'll try to guide y'all through an analysis of this. Scroll down. Gene G. In a message dated 7/22/2004 2:50:31 PM Central Daylight Time, supervisor@... writes: I've sent this out before, but received very little input other than a few opinions. Does anyone have any factual info? If a person signs a DNR while they are competent and able to make reasonable and informed decisions about their healthcare, can a family member or POA revoke or rescind that DNR later in the person's life when they are deemed to be incompetent or unable to decide for themselves? Go to this site and look at the form, and it will explain the procedures clearly. http://www.tdh.state.tx.us/hcqs/ems/dnr.pdf The patient may execute the DNR at a time when he is mentally competent (an incorrect term--the patient must possess " present legal capacity " as well as being legally mentally competent. Loose language has been an ongoing problem with these issues). If the patient is lacks the capacity to execute the DNR, it may be executed by anyone who has the legal right to make such a determination under the law, which is found in the Texas Family Code for Texas patients. If there are no patient surrogates available or they do not want to act, two physicians may execute the document. The DNR may be revoked by ANY of the persons qualified to execute it. Therefore, it a patient has executed a DNR at a time when he had present mental capacity and legal competence, but later becomes incompetent, any of the surrogates may revoke it. This is spelled out in detail on the back of the official DNR form. Best, GG Bullard BS, LP Training Coordinator Lubbock Aid Ambulance Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2004 Report Share Posted July 25, 2004 Gene, Thanks for the answer. That’s what I thought, but as I understand the intent when this was discussed in the legislature, it was to be a vehicle for people who did not want to be resuscitated to be able to let us to let them die in peace. Now we have dissected the wording to mean do what the family wants. Doesn’t this defeat the original intent of the law? Ralph , LP wegandy1938@... wrote: Ralph, Great question. I interpret the law to say " yes. " There have been no court decisions on that subject, so any answer that I give is presumptive, but on the theory of always working the code when in doubt, I would say work it to be safe. Now, I'll twist your mind a little bit. Let's say that there are a son and a daughter present who are both adults and one of them wants her worked and the other one does not. What then? GG In a message dated 7/23/2004 8:06:28 AM Central Daylight Time, rbr@... writes: Gene, Does this mean that if granny has a cardiac arrest with a DNR on hand, that her son can revoke it because she is no longer possess " present legal capacity " and is not legally mentally competent? Ralph , LP wegandy1938@... wrote: I'll try to guide y'all through an analysis of this. Scroll down. Gene G. In a message dated 7/22/2004 2:50:31 PM Central Daylight Time, supervisor@... writes: I've sent this out before, but received very little input other than a few opinions. Does anyone have any factual info? If a person signs a DNR while they are competent and able to make reasonable and informed decisions about their healthcare, can a family member or POA revoke or rescind that DNR later in the person's life when they are deemed to be incompetent or unable to decide for themselves? Go to this site and look at the form, and it will explain the procedures clearly. http://www.tdh.state.tx.us/hcqs/ems/dnr.pdf The patient may execute the DNR at a time when he is mentally competent (an incorrect term--the patient must possess " present legal capacity " as well as being legally mentally competent. Loose language has been an ongoing problem with these issues). If the patient is lacks the capacity to execute the DNR, it may be executed by anyone who has the legal right to make such a determination under the law, which is found in the Texas Family Code for Texas patients. If there are no patient surrogates available or they do not want to act, two physicians may execute the document. The DNR may be revoked by ANY of the persons qualified to execute it. Therefore, it a patient has executed a DNR at a time when he had present mental capacity and legal competence, but later becomes incompetent, any of the surrogates may revoke it. This is spelled out in detail on the back of the official DNR form. Best, GG Bullard BS, LP Training Coordinator Lubbock Aid Ambulance Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2004 Report Share Posted July 25, 2004 Gene, Thanks for the answer. That’s what I thought, but as I understand the intent when this was discussed in the legislature, it was to be a vehicle for people who did not want to be resuscitated to be able to let us to let them die in peace. Now we have dissected the wording to mean do what the family wants. Doesn’t this defeat the original intent of the law? Ralph , LP wegandy1938@... wrote: Ralph, Great question. I interpret the law to say " yes. " There have been no court decisions on that subject, so any answer that I give is presumptive, but on the theory of always working the code when in doubt, I would say work it to be safe. Now, I'll twist your mind a little bit. Let's say that there are a son and a daughter present who are both adults and one of them wants her worked and the other one does not. What then? GG In a message dated 7/23/2004 8:06:28 AM Central Daylight Time, rbr@... writes: Gene, Does this mean that if granny has a cardiac arrest with a DNR on hand, that her son can revoke it because she is no longer possess " present legal capacity " and is not legally mentally competent? Ralph , LP wegandy1938@... wrote: I'll try to guide y'all through an analysis of this. Scroll down. Gene G. In a message dated 7/22/2004 2:50:31 PM Central Daylight Time, supervisor@... writes: I've sent this out before, but received very little input other than a few opinions. Does anyone have any factual info? If a person signs a DNR while they are competent and able to make reasonable and informed decisions about their healthcare, can a family member or POA revoke or rescind that DNR later in the person's life when they are deemed to be incompetent or unable to decide for themselves? Go to this site and look at the form, and it will explain the procedures clearly. http://www.tdh.state.tx.us/hcqs/ems/dnr.pdf The patient may execute the DNR at a time when he is mentally competent (an incorrect term--the patient must possess " present legal capacity " as well as being legally mentally competent. Loose language has been an ongoing problem with these issues). If the patient is lacks the capacity to execute the DNR, it may be executed by anyone who has the legal right to make such a determination under the law, which is found in the Texas Family Code for Texas patients. If there are no patient surrogates available or they do not want to act, two physicians may execute the document. The DNR may be revoked by ANY of the persons qualified to execute it. Therefore, it a patient has executed a DNR at a time when he had present mental capacity and legal competence, but later becomes incompetent, any of the surrogates may revoke it. This is spelled out in detail on the back of the official DNR form. Best, GG Bullard BS, LP Training Coordinator Lubbock Aid Ambulance Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2004 Report Share Posted July 25, 2004 Gene, Thanks for the answer. That’s what I thought, but as I understand the intent when this was discussed in the legislature, it was to be a vehicle for people who did not want to be resuscitated to be able to let us to let them die in peace. Now we have dissected the wording to mean do what the family wants. Doesn’t this defeat the original intent of the law? Ralph , LP wegandy1938@... wrote: Ralph, Great question. I interpret the law to say " yes. " There have been no court decisions on that subject, so any answer that I give is presumptive, but on the theory of always working the code when in doubt, I would say work it to be safe. Now, I'll twist your mind a little bit. Let's say that there are a son and a daughter present who are both adults and one of them wants her worked and the other one does not. What then? GG In a message dated 7/23/2004 8:06:28 AM Central Daylight Time, rbr@... writes: Gene, Does this mean that if granny has a cardiac arrest with a DNR on hand, that her son can revoke it because she is no longer possess " present legal capacity " and is not legally mentally competent? Ralph , LP wegandy1938@... wrote: I'll try to guide y'all through an analysis of this. Scroll down. Gene G. In a message dated 7/22/2004 2:50:31 PM Central Daylight Time, supervisor@... writes: I've sent this out before, but received very little input other than a few opinions. Does anyone have any factual info? If a person signs a DNR while they are competent and able to make reasonable and informed decisions about their healthcare, can a family member or POA revoke or rescind that DNR later in the person's life when they are deemed to be incompetent or unable to decide for themselves? Go to this site and look at the form, and it will explain the procedures clearly. http://www.tdh.state.tx.us/hcqs/ems/dnr.pdf The patient may execute the DNR at a time when he is mentally competent (an incorrect term--the patient must possess " present legal capacity " as well as being legally mentally competent. Loose language has been an ongoing problem with these issues). If the patient is lacks the capacity to execute the DNR, it may be executed by anyone who has the legal right to make such a determination under the law, which is found in the Texas Family Code for Texas patients. If there are no patient surrogates available or they do not want to act, two physicians may execute the document. The DNR may be revoked by ANY of the persons qualified to execute it. Therefore, it a patient has executed a DNR at a time when he had present mental capacity and legal competence, but later becomes incompetent, any of the surrogates may revoke it. This is spelled out in detail on the back of the official DNR form. Best, GG Bullard BS, LP Training Coordinator Lubbock Aid Ambulance Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2004 Report Share Posted July 25, 2004 How many personal injury attorneys does it take to change a light bulb? Four--one to turn the bulb, one to shake him off the ladder, the third to sue the ladder company, the fourth to sue the paramedics called to the scene. Or Did you hear about the lawyer hurt in an accident? An ambulance stopped suddenly. Re: DNR Again In a message dated 7/24/2004 3:24:08 PM Central Standard Time, wegandy1938@... writes: Most doctors will treat the lawyers who get them out of their speeding tickets, handle their divorces and try to save their fortunes for them when their wife comes home early on Wednesday afternoon and catches them in bed with Nurse Barbie, and who set up their corporations for them and show them how to hide their assets in Grand Cayman. I was hoping that young barrister Wes was going to do all of the above for me but no he goes and gets a REAL JOB with the State no less! Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI LNMolino@... (Home Office) (Cell Phone) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2004 Report Share Posted July 25, 2004 How many personal injury attorneys does it take to change a light bulb? Four--one to turn the bulb, one to shake him off the ladder, the third to sue the ladder company, the fourth to sue the paramedics called to the scene. Or Did you hear about the lawyer hurt in an accident? An ambulance stopped suddenly. Re: DNR Again In a message dated 7/24/2004 3:24:08 PM Central Standard Time, wegandy1938@... writes: Most doctors will treat the lawyers who get them out of their speeding tickets, handle their divorces and try to save their fortunes for them when their wife comes home early on Wednesday afternoon and catches them in bed with Nurse Barbie, and who set up their corporations for them and show them how to hide their assets in Grand Cayman. I was hoping that young barrister Wes was going to do all of the above for me but no he goes and gets a REAL JOB with the State no less! Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI LNMolino@... (Home Office) (Cell Phone) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2004 Report Share Posted July 26, 2004 Just thought this side note might interest some. . . Brief Communication: The Relationship between Having a Living Will and Dying in Place B. Degenholtz, PhD; YongJoo Rhee, MPH, PhD; and M. Arnold, MD 20 July 2004 | Volume 141 Issue 2| Pages 113-117 Background: Living wills, a type of advance directive, are promoted as a way for patients to document preferences for life-sustaining treatments should they become incompetent. Previous research, however, has found that these documents do not guide decision making in the hospital. Objective: To test the hypothesis that people with living wills are less likely to die in a hospital than in their residence before death. Design: Secondary analysis of data from a nationally representative longitudinal study. Setting: Publicly available data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Patients: People older than 70 years of age living in the community in 1993 who died between 1993 and 1995. Measurements: Self-report and proxy informant interviews conducted in 1993 and 1995. Results: Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community. For people living in the community, the probability of in-hospital death decreased from 0.65 (95% CI, 0.58 to 0.71) to 0.52 (CI, 0.42 to 0.62). For people living in nursing homes, the probability of in-hospital death decreased from 0.35 (CI, 0.23 to 0.49) to 0.13 (CI, 0.07 to 0.22). Limitations: Retrospective survey data do not contain detailed clinical information on whether the living will was consulted. Conclusion: Living wills are associated with dying in place rather than in a hospital. This implies that previous research examining only people who died in a hospital suffers from selection bias. During advance care planning, physicians should discuss patients' preferences for location of death. Complete text here: http://www.annals.org/cgi/content/full/141/2/113 Rick LaChance, UTSWMC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2004 Report Share Posted July 26, 2004 Just thought this side note might interest some. . . Brief Communication: The Relationship between Having a Living Will and Dying in Place B. Degenholtz, PhD; YongJoo Rhee, MPH, PhD; and M. Arnold, MD 20 July 2004 | Volume 141 Issue 2| Pages 113-117 Background: Living wills, a type of advance directive, are promoted as a way for patients to document preferences for life-sustaining treatments should they become incompetent. Previous research, however, has found that these documents do not guide decision making in the hospital. Objective: To test the hypothesis that people with living wills are less likely to die in a hospital than in their residence before death. Design: Secondary analysis of data from a nationally representative longitudinal study. Setting: Publicly available data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Patients: People older than 70 years of age living in the community in 1993 who died between 1993 and 1995. Measurements: Self-report and proxy informant interviews conducted in 1993 and 1995. Results: Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community. For people living in the community, the probability of in-hospital death decreased from 0.65 (95% CI, 0.58 to 0.71) to 0.52 (CI, 0.42 to 0.62). For people living in nursing homes, the probability of in-hospital death decreased from 0.35 (CI, 0.23 to 0.49) to 0.13 (CI, 0.07 to 0.22). Limitations: Retrospective survey data do not contain detailed clinical information on whether the living will was consulted. Conclusion: Living wills are associated with dying in place rather than in a hospital. This implies that previous research examining only people who died in a hospital suffers from selection bias. During advance care planning, physicians should discuss patients' preferences for location of death. Complete text here: http://www.annals.org/cgi/content/full/141/2/113 Rick LaChance, UTSWMC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2004 Report Share Posted July 26, 2004 Just thought this side note might interest some. . . Brief Communication: The Relationship between Having a Living Will and Dying in Place B. Degenholtz, PhD; YongJoo Rhee, MPH, PhD; and M. Arnold, MD 20 July 2004 | Volume 141 Issue 2| Pages 113-117 Background: Living wills, a type of advance directive, are promoted as a way for patients to document preferences for life-sustaining treatments should they become incompetent. Previous research, however, has found that these documents do not guide decision making in the hospital. Objective: To test the hypothesis that people with living wills are less likely to die in a hospital than in their residence before death. Design: Secondary analysis of data from a nationally representative longitudinal study. Setting: Publicly available data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Patients: People older than 70 years of age living in the community in 1993 who died between 1993 and 1995. Measurements: Self-report and proxy informant interviews conducted in 1993 and 1995. Results: Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community. For people living in the community, the probability of in-hospital death decreased from 0.65 (95% CI, 0.58 to 0.71) to 0.52 (CI, 0.42 to 0.62). For people living in nursing homes, the probability of in-hospital death decreased from 0.35 (CI, 0.23 to 0.49) to 0.13 (CI, 0.07 to 0.22). Limitations: Retrospective survey data do not contain detailed clinical information on whether the living will was consulted. Conclusion: Living wills are associated with dying in place rather than in a hospital. This implies that previous research examining only people who died in a hospital suffers from selection bias. During advance care planning, physicians should discuss patients' preferences for location of death. Complete text here: http://www.annals.org/cgi/content/full/141/2/113 Rick LaChance, UTSWMC Quote Link to comment Share on other sites More sharing options...
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