By Georgina Kenyon
LONDON (Reuters Health) Sept 27 - Living wills or advance directives are prone to subjective interpretation, according to UK research findings presented at the Fifth World Congress of Bioethics here.
According to Dr. Trevor Thompson, from the department of general practice, University of Glasgow, who conducted the research, "like it or not, medical practitioners are prone to clinical judgments when a patient is ill, even if this is contradicting the patient's advance directive."
Dr. Thompson and colleagues interviewed four general practitioners, four nurses, four hospital physicians and a seven-member focus group that included consultant surgeons and hospice workers.
The surveyed healthcare providers were given a case study of a 78-year-old woman with dementia who had contracted pneumonia, and whose advance directive, written 8 years previously, requested that if she developed irreversible mental damage and fell ill, she should not be given antibiotics.
Five of the physicians and nurses said they favored treatment with antibiotics despite the patient's advance directive, while six said they would not and one said he did not know. Four of the seven members of the focus group said that they would not intervene.
Dr. Juan Carlos Siurana, a bioethicist from Etna, in Spain, told congress attendees that advanced directives are not suitable for some countries, such as Spain and Japan, because of the expectations of family to decide about the care of anyone ill.
In the United States, medical teams may be liable for prosecution if
they do not follow advanced directives of a patient, he added. There is
no legislation as yet about advance directives in the UK.